Angiographic assessment of prospectively determined non-invasive reperfusion indices in acute myocardial infarction

Objective-To investigate the value of non-invasive reperfusion indices in a cute myocardial infarction, avoiding the possible need for acute coronary a ngiography and subsequent angioplasty. Design-In a prospective angiographic study, seven potential ECG or clinical markers of reperfusion were analysed in 230 patients with acute myocardial infarction. In all patients two 12 lead ECGs were used: the ECG on admissi on and the ECG immediately before coronary angiography. Non-invasive marker s of reperfusion determined just before coronary angiography were prospecti vely correlated to thrombolysis in myocardial infarction (TIMI) flow. Data analysis correlated these non-invasive indices with coronary flow (analysis A: TIMI 2-3 v TIMI 0-1 flow; analysis B: TIMI 3 v TIMI 0-2 flow). Results-A sudden decrease in chest pain was the most common sign of reperfu sion (36%), followed by reduction in ST segment elevation by greater than o r equal to 50% (30%), and the development of a terminal negative T wave (20 %) in the lead with the highest ST segment elevation. Reduction in ST segme nt elevation by greater than or equal to 50% and the appearance of an accel erated idioventricular rhythm (AIVR) had the highest positive predictive va lue for reperfusion. For analyses A and B, the positive predictive values w ere 85% and 66% fur resolution of ST segment elevation, and 94% and 59% for AIVR, respectively. The presence of three or more non-invasive markers of reperfusion predicted TIMI 3 flow accurately in 80% of cases. Conclusions-The prospective use of non-invasive indices of reperfusion is s imple, practical, and can be of value in assessing coronary patency in pati ents admitted with acute myocardial infarction. Using these indices, discri mination between TIMI 0-1 anal TIMI 2-3 flow can be made with good accuracy . However, TIMI 3 flow cannot be determined reliably. The use of such non-i nvasive indices depends on the goal of reperfusion.