EARLY ELECTROCARDIOGRAPHIC CHANGES IN ACUTE MYOCARDIAL-INFARCTION TREATED BY STREPTOKINASE OR ALTEPLASE - A RANDOMIZED STUDY WITH DYNAMIC, MULTI-LEAD, ELECTROCARDIOGRAPHIC MONITORING

Patients with a patent coronary artery after reperfusion therapy show an increased rate of evolution of QRS changes and of resolution of S-T changes as compared to patients with a persistent occlusion. Dynamic vectorcardiography permits multi-lead monitoring of changes in QRS com plex and S-T segment over time. We monitored 150 patients randomized t o alteplase or streptokinase for 24 h after admission. Alteplase was a ssociated with significantly more rapid evolution of electrocardiograp hic changes but also with an increased occurrence of recurrent S-T cha nges. This may indicate a higher rate of early reperfusion with altepl ase but due to recurrent ischemia, an electrocardiographic catch-up is seen with similar extent of myocardial damage observed after 24 h of monitoring.