title: Angiographic assessment of prospectively determined non-invasive reperfusion indices in acute myocardial infarction.
abstract: OBJECTIVE
  To investigate the value of non-invasive reperfusion indices in acute myocardial infarction, avoiding the possible need for acute coronary angiography and subsequent angioplasty.
  
  
  METHODS
  In a prospective angiographic study, seven potential ECG or clinical markers of reperfusion were analysed in 230 patients with acute myocardial infarction. In all patients two 12 lead ECGs were used: the ECG on admission and the ECG immediately before coronary angiography. Non-invasive markers of reperfusion determined just before coronary angiography were prospectively correlated to thrombolysis in myocardial infarction (TIMI) flow. Data analysis correlated these non-invasive indices with coronary flow (analysis A: TIMI 2-3 v TIMI 0-1 flow; analysis B: TIMI 3 v TIMI 0-2 flow).
  
  
  RESULTS
  A sudden decrease in chest pain was the most common sign of reperfusion (36%), followed by reduction in ST segment elevation by >/= 50% (30%), and the development of a terminal negative T wave (20%) in the lead with the highest ST segment elevation. Reduction in ST segment elevation by > or = 50% and the appearance of an accelerated idioventricular rhythm (AIVR) had the highest positive predictive value for reperfusion. For analyses A and B, the positive predictive values were 85% and 66% for resolution of ST segment elevation, and 94% and 59% for AIVR, respectively. The presence of three or more non-invasive markers of reperfusion predicted TIMI 3 flow accurately in 80% of cases.
  
  
  CONCLUSIONS
  The prospective use of non-invasive indices of reperfusion is simple, practical, and can be of value in assessing coronary patency in patients admitted with acute myocardial infarction. Using these indices, discrimination between TIMI 0-1 and TIMI 2-3 flow can be made with good accuracy. However, TIMI 3 flow cannot be determined reliably. The use of such non-invasive indices depends on the goal of reperfusion.
authors.affiliation: Department of Cardiology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands. ton@oude.ophuis.net
authors.forename: A J
authors.initials: AJ
authors.lastname: Ophuis
authors.forename: F W
authors.initials: FW
authors.lastname: Bär
authors.forename: F
authors.initials: F
authors.lastname: Vermeer
authors.forename: W
authors.initials: W
authors.lastname: Janssen
authors.forename: P A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: R J
authors.initials: RJ
authors.lastname: Haest
authors.forename: W R
authors.initials: WR
authors.lastname: Dassen
authors.forename: H J
authors.initials: HJ
authors.lastname: Wellens
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome