THE DISTINCTION BETWEEN CORONARY AND MYOCARDIAL REPERFUSION AFTER THROMBOLYTIC THERAPY BY CLINICAL MARKERS OF REPERFUSION

Objectives. We sought to examine the hypothesis that rapid resolution of ST-segment elevation in acute myocardial infarction (AMI) patients with early peak creatine kinase (CK) after thrombolytic therapy differ entiates among patients with early recanalization between those with a nd those without adequate tissue (myocardial) reperfusion, Background. Early recanalization of the epicardial infarct-related artery (IRA) d uring AMI does not ensure adequate reperfusion on the myocardial level . While early peak CK after thrombolysis results from early and abrupt restoration of the coronary flow to the infarcted area, rapid ST-segm ent resolution, which is another clinical marker of successful reperfu sion, reflects changes of the myocardial tissue itself, Methods. We co mpared the clinical and the angiographic results of 162 AMI patients w ith early peak CK (less than or equal to 12 h) after thrombolytic ther apy with (group A) and without (group B) concomitant rapid resolution of ST-segment elevation. Results. Patients in groups A and B had simil ar patency rates of the IRA on angiography (anterior infarction: 93% v s. 93%; inferior infarction: 89% vs. 77%). Nevertheless, group A versu s B patients had lower peak CK (anterior infarction: 1,083 +/- 585 IU/ ml vs. 1,950 +/- 1,216, p < 0.01; and inferior infarction: 940 +/- 750 IU/ml vs. 1,350 +/- 820, p = 0.18) and better left ventricular ejecti on fraction (anterior infarction: 49 +/- 8, vs. 44 +/- 8, p < 0.01; in ferior infarction: 56 +/- 12 vs. 51 +/- 10, p = 0.1). In a 2-year foll ow-up, group A as compared with group B patients had a lower rate of c ongestive heart failure (1% vs, 13%, p < 0.01) and mortality (2% vs. 1 3%, p < 0.01). Conclusions. Among patients in whom reperfusion appears to have taken place using an early peak CK as a marker, the coexisten ce of rapid resolution of ST-segment elevation further differentiates among patients with an opened culprit artery between the ones with and without adequate myocardial reperfusion, (C) 1998 by the American Col lege of Cardiology.