EARLY RECURRENCE OF ST-SEGMENT ELEVATION IN PATIENTS WITH INITIAL REPERFUSION DURING THROMBOLYTIC THERAPY - IMPACT ON IN-HOSPITAL REINFARCTION AND LONG-TERM VESSEL PATENCY

Aim: To investigate the frequency and prognostic impact of early recur rent ST-segment elevation after initial ST-segment resolution in patie nts with acute myocardial infarction who had been treated with intrave nous thrombolysis. Methods: Eighty-one patients with acute myocardial infarction underwent 24 h Hotter monitoring of the infarct-related ST- segment elevation, at the initiation of thrombolytic therapy. Angiogra phy was performed in 88% of the patients 9+/-4 days after infarction. Results: Resolution of the ST-segment elevation during the first 4 h, suggestive of early reperfusion, occurred in 67 (83%) patients (group 1). Of these, 31 (46%) had subsequent re-elevations (group la), 26 dur ing the first 4h, and 20 later. Thirty-six (54%) patients had no recur rence of the ST-segment elevation (group Ib). During follow-up, patien ts in group la experienced more in-hospital reinfarctions (26 versus 6 %, P=0.04) and had a higher rate of occluded infarct-related vessels a t angiography than patients in group Ib (40 versus 17%, P=0.01). Concl usion: During the first 24 h after initiation of thrombolytic therapy, recurrences of ST-segment elevation are frequent in myocardial infarc tion patients with ECG signs of an initially reperfused infarct-relate d artery. Recurrence of ST-segment elevation indicates a higher risk o f reinfarction during hospitalization and of long-term occlusion of th e infarct artery.