ST-segment and myocardial enzymes evolution during myocardial infarction after fibrinolysis therapy and its relation with postinfarction angina, Killip class and mortality in intensive unit care

Introduction. The prognostic value of enzyme peaks, the sum of the ST segme nt and reperfusion arrythmias during myocardial infarction remains unclear. Objectives. The aim of this study was to relate the early enzymatic peaks, the sum of the ST segment and reperfusion arrythmias after thrombolytic the rapy with postinfarction angina, Killip class and mortality during the acut e phase of myocardial infarction. Patients and Methods. Of 187 patients receiving fibrinolytic therapy, 169 w ere consecutively and prospectively included in the study. The following my ocardial enzymes were determined: CK, MB, TGO, LDH. Electrocardiograms were performed prior to and 2, 6, 12 and 24 hours after the administration of t he fibronolytic drug. Results. The mean age of the patients was 60.12 +/- 11.3 years, with 138 (8 1.7%) being males. Myocardial infarction was anterior in 74 (43.7%) and inf erior in 95 cases (56.3%). Reperfusion arrythmias were observed in 65 cases (38.5%). One hundred thirty-one (77.5%) were Killip class 1, 12 (7.1%) pre sented postinfarction angina, and 8 (4.7%) died. A peak was observed in MB at 6 hours in cases of anterior myocardial infarc tion and the sum of the ST segment decreased less than 50% in the first 2 h ours. No statistically significant correlation was observed between the enymatic peaks, the reperfusion arrythmias, Killip class, postinfarction angina or e arly mortality. The greater the ST segment sum, the greater the severity ac cording to the Killip class. On multivariate analysis no model was found to be related to postinfarction angina. However. age was related to mortality and sex and age were associated with heart failure. Conclusions. In our population, the variables studied were not found to be useful to determine the prognosis during the early phase of acute myocardia l infarction.