Association of the timing of ST-segment resolution with TIMI myocardial perfusion grade in acute myocardial infarction.
BACKGROUND
More complete ST-segment resolution (ST res) in acute myocardial infarction (MI) has been associated with better epicardial and myocardial reperfusion as assessed with the Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG) and the TIMI myocardial perfusion grade (TMPG), respectively. However, no data exist comparing the speed of ST resolution on continuous electrocardiogram (ECG) monitoring with the TMPG on coronary angiography. We hypothesized that delayed ST res is associated with impaired TMPGs.


METHODS
Continuous 12-lead ECG recordings and 60-minute angiographic data were analyzed in 120 patients with acute MI who received tenectaplase monotherapy or combination therapy with low-dose tenectaplase and eptifibatide in the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial.


RESULTS
More rapid ST res on continuous ECG monitoring was associated with improved TMPGs on coronary angiography performed 60 minutes after study drug administration. For TMPG 3, the median time to ST resolution was 53 minutes. For TMPG 2, 1, and 0, the corresponding times were 64 minutes, 80 minutes, and 106 minutes, respectively (P =.01 for trend). Likewise, more rapid ST res was also associated with faster epicardial flow. For TFG 3, the median time to ST resolution was 46 minutes, compared with 109 minutes for TIMI flow grades 0 to 2 (P =.001). The corresponding times for a corrected TIMI frame count < or =40 versus >40 were 52 minutes and 112 minutes, respectively (P <.001).


CONCLUSIONS
Although the static ECG has been associated with epicardial and myocardial blood flow in the past, this study extends these observations to demonstrate that more rapid ST res on continuous ECG monitoring is associated with improved myocardial perfusion after thrombolytic administration.
Gibson
C Michael
CM
TIMI Study Group, the Department of Medicine, Brigham & Women's Hospital, Boston, Mass, USA.
Karha
Juhana
J
Giugliano
Robert P
RP
Roe
Mathew T
MT
Murphy
Sabina A
SA
Harrington
Robert A
RA
Green
Cindy L
CL
Schweiger
Marc J
MJ
Miklin
Jerry S
JS
Baran
Kenneth W
KW
Palmeri
Sebastian
S
Braunwald
Eugene
E
Krucoff
Mitchell W
MW
D000368:Aged; D017322:Clinical Trials, Phase II as Topic; D017023:Coronary Angiography; D004562:Electrocardiography; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D015425:Myocardial Reperfusion; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D000077785:Tenecteplase; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator; D000077542:Eptifibatide; D000077785:Tenecteplase