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Comparison of a 60- versus 90-minute determination of ST-segment resolution after thrombolytic therapy for acute myocardial infarction

      Assessment of ST-segment resolution early after the administration of thrombolytic therapy provides important insight into the efficacy of myocardial reperfusion. ST resolution is widely used to risk-stratify patients after thrombolyis and to guide decisions regarding adjunctive interventions. Greater degrees of ST resolution 90 to180 minutes after thrombolysis are associated with better recovery of left ventricular function and reduced mortality.
      • Schröder R.
      • Dissmann R.
      • Bruggemann T.
      • Wegscheider K.
      • Linderer T.
      • Tebbe U.
      • Neuhaus K.-L.
      Extent of early ST segment elevation resolution a simple but strong predictor of outcome in patients with acute myocardial infarction.
      ,
      • Schröder R.
      • Wegscheider K.
      • Schroder K.
      • Dissmann R.
      • Meyer-Sabellek W.
      INJECT Trial Group
      Extent of early ST segment elevation resolution a strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. A substudy of the International Joint Efficacy Comparison of Thrombolytics (INJECT) trial.
      ,
      • Mauri R.
      • Maggioni A.P.
      • Franzosi M.G.
      • De Vita C.
      • Santoro E.
      • Santoro L.
      • Giannuzzi P.
      • Tognoni G.
      GISSI-2 Investigators
      A simple electrocardiographic predictor of the outcome of patients with acute myocardial infarction treated with a thrombolytic agent. A Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-2)-derived analysis.
      Patients with complete (≥70%) ST resolution 90 minutes after thrombolysis are ∼95% likely to have a patent infarct artery (IRA).
      • de Lemos J.A.
      • Antman E.M.
      • McCabe C.H.
      • Murphy S.A.
      • Gibson C.M.
      • Braunwald E.
      Thrombolysis in Myocardial Infarction (TIMI) 14 Investigators
      ST-segment resolution and infarct related artery patency and flow after thrombolytic therapy.
      In contrast, when ST resolution fails to occur, 1 of 2 scenarios is generally present: either the IRA remains occluded, or, alternatively, the IRA is patent but extensive tissue and microvascular injury have occurred.
      • de Lemos J.A.
      • Antman E.M.
      • McCabe C.H.
      • Murphy S.A.
      • Gibson C.M.
      • Braunwald E.
      Thrombolysis in Myocardial Infarction (TIMI) 14 Investigators
      ST-segment resolution and infarct related artery patency and flow after thrombolytic therapy.
      ,
      • Santoro G.M.
      • Valenti R.
      • Buonamici P.
      • Bolognese L.
      • Cerisano G.
      • Moschi G.
      • Trapani M.
      • Antoniucci D.
      • Fazzini P.F.
      Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty.
      In either case, the patient remains at risk for congestive heart failure and death. Although considerable data support the assessment of ST resolution at 90 and 180 minutes after thrombolysis, few data are available evaluating earlier determinations of ST resolution. An earlier measurement might facilitate a more rapid decision about the use of “rescue” percutaneous coronary intervention. The objective of the present study was to compare a 60- versus a 90-minute measurement of ST resolution.
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      References

        • Schröder R.
        • Dissmann R.
        • Bruggemann T.
        • Wegscheider K.
        • Linderer T.
        • Tebbe U.
        • Neuhaus K.-L.
        Extent of early ST segment elevation resolution.
        J Am Coll Cardiol. 1994; 24: 384-391
        • Schröder R.
        • Wegscheider K.
        • Schroder K.
        • Dissmann R.
        • Meyer-Sabellek W.
        • INJECT Trial Group
        Extent of early ST segment elevation resolution.
        J Am Coll Cardiol. 1995; 26: 1657-1664
        • Mauri R.
        • Maggioni A.P.
        • Franzosi M.G.
        • De Vita C.
        • Santoro E.
        • Santoro L.
        • Giannuzzi P.
        • Tognoni G.
        • GISSI-2 Investigators
        A simple electrocardiographic predictor of the outcome of patients with acute myocardial infarction treated with a thrombolytic agent. A Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-2)-derived analysis.
        J Am Coll Cardiol. 1994; 24: 600-607
        • de Lemos J.A.
        • Antman E.M.
        • McCabe C.H.
        • Murphy S.A.
        • Gibson C.M.
        • Braunwald E.
        • Thrombolysis in Myocardial Infarction (TIMI) 14 Investigators
        ST-segment resolution and infarct related artery patency and flow after thrombolytic therapy.
        Am J Cardiol. 2000; 85: 299-304
        • Santoro G.M.
        • Valenti R.
        • Buonamici P.
        • Bolognese L.
        • Cerisano G.
        • Moschi G.
        • Trapani M.
        • Antoniucci D.
        • Fazzini P.F.
        Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty.
        Am J Cardiol. 1998; 82: 932-937
        • Ferguson J.J.
        Meeting highlights. Highlights of the 48th scientific sessions of the American College of Cardiology (news).
        Circulation. 1999; 100: 570-575
        • Shah A.
        • Wagner G.S.
        • Granger C.B.
        • O’Connor C.M.
        • Green C.L.
        • Trollinger K.M.
        • Califf R.M.
        • Krucoff M.W.
        Prognostic implications of TIMI flow grade in the infarct related artery compared with continuous 12-lead ST-segment resolution analysis.
        J Am Coll Cardiol. 2000; 35: 666-672
        • Ito H.
        • Tomooka T.
        • Sakai N.
        • Yu H.
        • Higashino Y.
        • Fujii K.
        • Masuyama T.
        • Kitabatake A.
        • Minamino T.
        Lack of myocardial perfusion immediately after successful thrombolysis.
        Circulation. 1992; 85: 1699-1705
        • Dissmann R.
        • Linderer T.
        • Goerke M.
        • von Ameln H.
        • Rennhak U.
        • Schroder R.
        Sudden increase of the ST segment elevation at time of reperfusion predicts extensive infarcts in patients with intravenous thrombolysis.
        Am Heart J. 1993; 126: 832-839
        • van’t Hof A.
        • Liem A.
        • de Boer M.
        • Zijlstra F.
        Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction.
        Lancet. 1997; 350: 615-619
        • Matetzky S.
        • Novikov M.
        • Gruberg L.
        • Freimark D.
        • Feinberg M.
        • Elian D.
        • Novikov I.
        • Di Segni E.
        • Agranat O.
        • et al.
        The significance of persistent ST elevation versus early resolution of ST segment elevation after primary PTCA.
        J Am Coll Cardiol. 1999; 34: 1932-1938
        • Somitsu Y.
        • Nakamura M.
        • Degawa T.
        • Yamaguchi T.
        Prognostic value of slow resolution of ST-segment elevation following successful direct percutaneous transluminal coronary angioplasty for recovery of left ventricular function.
        Am J Cardiol. 1997; 80: 406-410
        • Claeys M.J.
        • Bosmans J.
        • Veenstra L.
        • Jorens P.
        • De Raedt H.
        • Vrints C.J.
        Determinants and prognostic implications of persistent ST-segment elevation after primary angioplasty for acute myocardial infarction.
        Circulation. 1999; 99: 1972-1977
        • Purcell I.F.
        • Newall N.
        • Farrer M.
        Change in ST segment elevation 60 minutes after thrombolytic initiation predicts clinical outcome as accurately as later electrocardiographic changes.
        Heart. 1997; 78: 465-471
        • Matetzky S.
        • Freimark D.
        • Chouraqui P.
        • Novikov I.
        • Agranat O.
        • Rabinowitz B.
        • Kaplinsky E.
        • Hod H.
        The distinction between coronary and myocardial reperfusion after thrombolytic therapy by clinical markers of reperfusion.
        J Am Coll Cardiol. 1998; 32: 1326-1330
        • Berger C.J.
        • Murabito J.M.
        • Evans J.C.
        • Anderson K.M.
        • Levy D.
        Prognosis after first myocardial infarction. Comparison of Q wave and non-Q wave myocardial infarction in the Framingham Heart Study.
        JAMA. 1992; 268: 1545-1551
        • Llevadot J.
        • Giugliano R.P.
        • McCabe C.H.
        • Cannon C.P.
        • Antman E.M.
        • Murphy S.
        • Gibson C.M.
        Degree of residual stenosis in the culprit coronary artery after thrombolytic administration (Thrombolysis in Myocardial Infarction (TIMI) Trials).
        Am J Cardiol. 2000; 85: 1409-1413