PREDICTION OF EARLY REPERFUSION AND LEFT-VENTRICULAR DAMAGE BY ST SEGMENT ANALYSIS DURING THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION

In 60 patients with acute myocardial infarction (pain less-than-or-equ al-to 4 h), we examined the value of ST segment monitoring in predicti ng early reperfusion, resulting left ventricular damage, and complicat ions during hospitalization. Two criteria were determined by observati on of the ST segment elevation during the first 4 h following initiati on of thrombolysis. Early reperfusion was assessed by an early increas e of the creatine phosphokinase (CK) with measurements taken in 15-min intervals. Cardiac catheterization was performed on days 11 +/- 5. Ac cording to the CK measurements, a reduction of the ST elevation greate r-than-or-equal-to 50 % within 1 h of serial ECG follow-up (ST criteri on A) was the best indicator of early reperfusion (sensitivity 84 %, s pecificity 80 % positive predictive value 93 %, negative predictive va lue 67 %). Simple comparison of the ST segment in the initial ECG and an ECG recorded 3 h later (ST criterion B) was less accurate according to the detection of early reperfusion (sensitivity 68 %, specitivity 93 %, positive predictive value 97 %, negative predictive value 50 %). However, contrary to ST criterion A, criterion B was useful in predic ting subsequent left ventricular damage. Patients with a resolution of the initial ST elevation greater-than-or-equal-to 70 %/3 h showed sma ller regional wall motion abnormalities (dyssynergic area 21.3 +/- 20. 3 vs 33.8 +/- 18.4, p < 0.01) and a better left ventricular ejection f raction (57.7 +/- 11.6 vs 50.2 +/- 12.6, p < 0.05). Patients with earl y reduction of the ST elevation following either criterion experienced fewer critical events (reinfarction, reischemia, death). In conclusio n, the investigated criteria are useful in assessing reperfusion of th e infarcted artery following thrombolysis. Simple comparison of the in itial ST elevation and the ST elevation after 3 h gives acute informat ion according to patient outcome. This ST criterion could be useful in selecting candidates who may profit from an early, more aggressive th erapeutical approach.