Additional ST-segment elevation during thrombolytic therapy in patients with acute ST-elevation myocardial infarction: impact on myocardial salvage and final infarct size.
The aim of the study was to investigate the clinical significance of additional ST-segment elevation that occurs during thrombolytic therapy. Therefore, we classified 153 patients with a first acute myocardial infarction (MI) into two groups: Group A, 55 patients with additional ST-segment elevation > or = 1 mm above the initial ST elevation during thrombolytic therapy and Group B, 98 patients without this electrocardiographic pattern. Among the patients with anterior MI, Group A (n = 33) had no reduction from ST-predicted to final QRS-estimated infarct size (+12% versus -27%; p = 0.0005) and a larger final infarct size (QRS-score: 18% versus 12%; p = 0.0002) than Group B (n = 41). Among the patients with inferior MI, Group A (n = 22) had a smaller reduction from ST-predicted to final QRS-estimated infarct size (-30% versus -53%; p = 0.03) and a larger final infarct size (QRS-score: 15% versus 9%; p = 0.03) than Group B (n = 57). The area under the curve (AUC) of CK and CK-MB was higher in patients from Group A compared with those from Group B (anterior MI: AUC-CK: 22,048 versus 19,490 U.h.l-1; p = 0.07; AUC-MB: 2227 versus 2016 U.h.l-1; p = 0.11; inferior MI: AUC-CK: 17,206 versus 11,004 U.h.l-1; p = 0.01; AUC-MB: 2193 versus 1046 U.h.l-1; p = 0.007). Both global left ventricular function and ST-segment elevation resolution were significantly better in Group B. Two and three vessel disease was observed more frequently in Group A. Additional ST-segment elevation during thrombolytic therapy suggests reduced myocardial salvage by thrombolytic therapy and thus may result in larger final infarct size.
Schreiber
Wolfgang
W
Department of Emergency Medicine, University of Vienna, Austria. wolfgang.schreiber@akh-wien.ac.at
Kittler
Harald
H
Herkner
Harald
H
Gwechenberger
Marianne
M
Laggner
Anton N
AN
Hirschl
Michael M
MM
D000368:Aged; D004796:Clinical Enzyme Tests; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D016879:Salvage Therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D016277:Ventricular Function, Left
D007527:Isoenzymes; D003402:Creatine Kinase