SUDDEN INCREASE OF THE ST SEGMENT ELEVATION AT TIME OF REPERFUSION PREDICTS EXTENSIVE INFARCTS IN PATIENTS WITH INTRAVENOUS THROMBOLYSIS

Within 4 hours from the onset of symptoms in 61 patients with myocardi al infarction and intravenous thrombolysis, ST segment elevation and c reatine phosphokinase (CK) were measured every 15 minutes. Because of a premature enzyme rise, 42 patients (69%) were reperfused early (grou p 1). Immediately following reperfusion, eight of them (13%, group 1a) showed a marked increase of the ST elevation, in six of whom it was a ssociated with clearly intensified chest pain. These patients exhibite d a much steeper enzyme release and developed a larger enzymatic infar ct size than patients (group lb) without an additional transient ST. e levation at reperfusion (CK peak 5.1 +/- 1.6 vs 9.8 +/- 4.2 hours afte r the start of thrombolysis; CK release 48 +/- 22 vs 19 +/- 18 IU/ml x hours, both p < 0.005). At angiography 11 days later, left ventricula r function was significantly worse in group la than in group 1b (regio nal dyssynergic area 51 +/- 24 vs 21 +/- 18, global ejection fraction 39 +/- 14 vs 58 +/- 11; both p < 0.0005). During intravenous thromboly sis in acute myocardial infarction, some patients show a marked transi ent increase of the ST segment elevation at reperfusion. Their enzyme rise is very rapid and suggests a special reperfusion pattern. Most of these patients suffered large infarcts.