ST-segment recovery adds to the assessment of TIMI 2 and 3 flow in predicting infarct wall motion after thrombolytic therapy

Background-Early resolution of ST-segment elevation (ST-segment recovery) i s associated with an improved outcome after infarction. Whether this relati on is present in patients with Thrombolysis In Myocardial Infarction (TIMI) grade 2 or 3 flow tie, patent) infarct-related arteries is not known. Methods and Results-To examine the associations between time to achieve sta ble 50% ST-segment recovery assessed by continuous ECG monitoring, infarct artery flow, and infarct zone wall motion (at 48 hours), we studied 134 pat ients who underwent angiography at 99 (interquartile range 92 to 110) minut es after commencing streptokinase, initiated within 12 hours of onset of sy mptoms of myocardial infarction, Patients with TIMI 2 or 3 flow who failed to achieve early stable ST-segment recovery (50% ST-segment recovery sustai ned for greater than or equal to 4 hours with <100 mu V change in the peak lead) by 60 or 90 minutes had a higher fraction of chords in the infarct zo ne >2 SD below normal wall motion (TIMI 3: 55.5% vs 15.3%, P=0.006; and 56. 5% vs 26.8%, P=0.01, respectively; and TIMI 3, 48.8% vs 28.3%, P=0.07; and 51.8% vs 29.9%, P=0.03, respectively). Time to stable ST-segment recovery w as a multivariate predictor of infarct zone wall motion (P=0.04) independen t of TIMI flow grade and the time from symptom onset to streptokinase thera py. Conclusions-In patients with TIMI 2 or 3 flow in infarct-related artery, ea rly stable ST-segment recovery is associated with improved infarct zone wal l motion at 48 hours. ST-segment recovery may provide additional informatio n about the degree of myocyte reperfusion achieved in patients with a paten t epicardial infarct-related artery after thrombolytic therapy.