MYOCARDIAL DAMAGE AFTER SUCCESSFUL THROMBOLYSIS IS ASSOCIATED WITH THE DURATION OF ST RE-ELEVATION AT REPERFUSION

The purpose of this study was to investigate the significance of ST re -elevation at reperfusion using strict criteria for patient inclusion and exclusion. Twenty-nine patients who had a first anterior infarctio n with single-vessel disease, successful recanalization by intracorona ry thrombolysis (ICT) with urokinase, and an angiographically confirme d patient infarct-related artery after 4 weeks, were divided into thre e groups according to the deviation of the ST segment at reper-fusion: Group A, 10 patients with sustained ST re-elevation; Group B, 10 pati ents with transient ST re-elevation; and Group C, 9 patients with ST r eduction. Left ventricular (LV) function was evaluated from cineventri culograms performed in the 30-degrees right anterior projection 4 week s after ICT.LV ejection fraction and regional wall motion of the infar ct area, evaluated by the centerline method (SD/chords), were signific antly lower in Group A (44 +/- 10%, - 3.2 +/- 0.4) than in Group B (61 +/- 9%, -1.9 +/- 0.7) and Group C (60 +/- 5%, - 2.0 +/- 0.4) (p <0.01 ). Peak creatine kinase (CK) activity was significantly higher in Grou p A (5848 +/- 2112 IU) than in Group B (2485 +/- 1254 IU) and Group C (1889 +/- 1525 IU) (p <0.05). These data suggest that a sustained ST r e-evaluation at reperfusion was strongly associated with marked LV dys function and higher peak CK activity. It was concluded that sustained, not transient, ST re-elevation associated with successful reperfusion indicates extensive myocardial damage.