The relationship between grade of ischemia, success of reperfusion, and type of thrombolytic regimen.
BACKGROUND
This study was aimed to determine whether the grade of ischemia can predict the success of reperfusion in patients treated with thrombolytic therapy (TT) for ST elevation myocardial infarction (STEMI).


METHODS
We enrolled 229 consecutive patients with diagnosis of STEMI and receiving TT. Patients were divided into 2 groups--grade 2 ischemia (GI2) and grade 3 ischemia (GI3)--according to initial electrocardiogram (ECG). As TT, fibrin-specific (tissue plasminogen activator (t-PA)) or non-fibrin-specific (streptokinase (SKZ)) regimens were used. Successful reperfusion was defined as >50% resolution of the maximal ST segment on 90-min ECG. We tried to evaluate whether the grade of ischemia could predict the success of reperfusion and if there were any differences in terms of successful reperfusion between different thrombolytic regimens.


RESULTS
The successful reperfusion rate was significantly higher in GI2 than GI3 (82.4% vs. 64.4% respectively, p=0.002). The success rate was lowest at anterior GI3 (55.8%). Although there was no significant difference between thrombolytic regimens in all groups (p=0.77), t-Pa was superior to SKZ in anterior GI3 (63,6% vs. 30%, p=0.061). In addition, in multivariate analysis, GI and infarct localization were found as independent predictors for successful reperfusion with TT (p=0.006 and p=0.042, respectively).


CONCLUSIONS
In the current study, we found that GI2 is an independent predictor for successful reperfusion in STEMI treated with TT. Fibrin specific regime should be preferred in anterior GI3.
Department of Cardiology, Bağcılar Education and Research Hospital, Bağcılar, Istanbul, Turkey.
Burak
B
Ayça
Department of Cardiology, Near East University, Nicosia, Cyprus.
Cenk
C
Conkbayır
Department of Cardiology, Istanbul University, Cardiology Institution, Haseki, Istanbul, Turkey.
Fahrettin
F
Katkat
Department of Cardiology, Near East University, Nicosia, Cyprus.
Kamil
K
Gulsen
Department of Cardiology, Sıtkı Koçman University, Muğla, Turkey.
Fatih
F
Akin
Department of Cardiology, Bağcılar Education and Research Hospital, Bağcılar, Istanbul, Turkey.
Ertuğrul
E
Okuyan
Department of Cardiology, Istanbul University, Cardiology Institution, Haseki, Istanbul, Turkey.
Murat
M
Baskurt
Department of Cardiology, Near East University, Nicosia, Cyprus.
Barıs
B
Okcun
D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D015425:Myocardial Reperfusion; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014463:Ultrasonography