Bedside markers of coronary artery patency and short-term prognosis of patients with acute myocardial infarction and thrombolysis

Background In this study we have evaluated the prognostic power of noninvas ive markers of coronary artery reperfusion in patients with acute myocardia l infarction who were treated with intravenous streptokinase. Methods In 967 consecutive patients with acute myocardial infarction who we re treated within 6 hours of symptoms, we analyzed the prognostic power of resolution of chest pain and ST-segment elevation >50% at 90 minutes, abrup t creatine kinase rise before 12 hours, and T-wave inversion in infarct-rel ated electrocardiographic leads within the first 24 hours after thrombolysi s. Results Global in-hospital mortality rate was 12.0%. Each reperfusion marke r was associated with improved outcome. Multivariate logistic regression an alysis showed that 3 of the 4 markers of coronary artery reperfusion were s ignificantly and independently associated to low in-hospital mortality rate . The presence of early T-wave inversion was associated with the lowest in- hospital mortality rate (odds ratio 0.25, confidence interval 0.10-0.56). W hen all markers of coronary artery reperfusion were included in the regress ion model, T-wave inversion (odds ratio 0.29, confidence interval 0.11-0.68 ) and abrupt creatine kinase rise (odds ratio 0.36, confidence interval 0.1 6-0.77) continued to be significantly associated with better outcome. Conclusion A systemic analysis of noninvasive markers of coronary artery re perfusion can provide the clinician with on excellent tool to predict clini cal outcomes when treating myocardial infarction.