PROGNOSTIC VALUE OF NON INVASIVE MARKERS OF CORONARY REPERFUSION IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION TREATED WITH THROMBOLYSIS

Background: The immediate prognosis of patients with acute myocardial infarction treated with thrombolysis primarily depends on obtaining a satisfactory coronary reperfusion. Aim: To assess the prognostic power of four markers of coronary artery patency in patients with acute myo cardial infarction treated with Streptokinase 1.5 million U within the first six hours of symptoms. Patients and methods: In 807 consecutive patients from the Chilean National Registry of Acute Myocardial Infar ction we analyzed the resolution of chest pain and ST segment elevatio n over 50% within the first 90 min, abrupt CK rise within 8 h and T wa ve inversion in infarct related EKG leads within the first 24 h after thrombolysis. Results: Global in-hospital mortality was 12.1%. Mortali ty of patients with the presence of 3 or 4 markers of coronary artery patency was 5.1%, in those with resolution of ST elevation and abrupt CK rise was 6.25% and in those with T wave inversion it was 3.9% (p< 0 .001). Multivariate analysis, adjusted by age, gender, risk factors, K illip class and infarct location showed that early T wave inversion wa s the better predictor of a low in-hospital mortality and that its com bination with other markers of coronary artery patency did not increas e its prognostic power. Early CK rise and the presence of 3 out of 4 r eperfusion criteria were also independent predictors of a low mortalit y. Conclusions: Non invasive markers of coronary artery patency are as sociated with a lower in-hospital mortality and may serve as surrogate end points in clinical trials.