Resolution of ST-segment elevation after streptokinase therapy in anterior versus inferior wall myocardial infarction.
BACKGROUND
Resolution of ST-segment elevation is the best bedside predictor of myocardial reperfusion.


OBJECTIVE
This study was conducted to examine the resolution of ST-segment elevation after streptokinase therapy in anterior versus inferior acute myocardial infarction (MI) and to corroborate it with echocardiographic and coronary angiographic data.


METHODS
The study population consisted of 70 patients, 35 each in the anterior and inferior MI groups. The electrocardiograms (ECGs) were recorded before, on completion of, and on Days 1 and 2 post streptokinase therapy. The resolution of ST segment determined from post-streptokinase ECGs was compared between the two groups and correlated with echocardiographic and coronary angiographic data.


RESULTS
On completion of and on Day 1 post streptokinase therapy, ST-segment resolution in both groups was not significantly different. On Day 2 post streptokinase therapy, resolution of the ST segment per lead was significantly lower in anterior than that in inferior MI (61 +/- 21% anterior vs. 77 +/- 21% inferior, p 0.003). The number of patients with akinesis of infarct-related ventricular wall was significantly higher (17 anterior vs. 7 inferior, p 0.02), and left ventricular ejection fraction was significantly lower in anterior MI (39 +/- 7% anterior vs. 48 +/- 8% inferior, p < 0.01). There was no significant difference in coronary angiographic data. One patient in each group demonstrated normal coronary arteries.


CONCLUSIONS
The resolution of ST-segment elevation on the completion of and on Day 1 post streptokinase therapy was comparable between anterior and inferior MI. The significantly less frequent resolution of ST-segment elevation in anterior MI on Day 2 post streptokinase could be due to more akinesis, larger infarct size, and worse systolic function rather than due to failure to open the infarct-related vessel.
Guzman
E
E
Division of Cardiology, Woodhull Medical Center, Brooklyn, New York, USA.
Khan
I A
IA
Rahmatullah
S I
SI
Verghese
C
C
Yi
K S
KS
Niarchos
A P
AP
Ansari
A W
AW
Cohen
R A
RA
D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D020127:Recovery of Function / Q000187:drug effects*; D012189:Retrospective Studies; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects
D013300:Streptokinase; D010960:Plasminogen Activators