Non invasive criteria of reperfusion after thrombolysis in acute myocardial infarction

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Abstract

In order to examine the relation between non-invasive reperfusion criteria and angiographic patency of acute myocardial infarction related coronary artery and also with left ventricular function, 184 patients who under- went left heart catheterisation were analyzed. All of them received intravenous thrombolytic treatment within 6 hours from the onset of acute myocardial infarction. The following criteria were considered, just before the infusion and two hours later: a) summatory of ST segment elevation (ECG criterium); b) CK value (enzimatic criterium), and c) anginal pain measured in a 1 to 10 score (clinical criterium). A reduction of 50 % or more in ST segment elevation sum or in the pain score or a more than two-fold increase in CK value were considered as positive criteria. The association between two or more criteria was calIed "reperfusion syndrome". Each individual criterium showed good correlation with myòcardial infarction-related coronary artery patency, but reperfusion syndrome met the best combination of sensitivity, specificity and predictive value. A positive reperfusion syndrome implied in 86 % probability of a patent vessel and a negative reperfusion syndrome implied in 87 % probability of an occluded one. A positive ECG criterium and a positive reperfusion syndrome predicted a higher angiographic ejectionfrac- tion even in the subgroup of patients with patent acute myocardial infarction-related vessel. It is concluded than non-invasive criteria and specially reperfusion syndrome are simple and useful markers of coronary reperfusion related to thrombolytic treatment and they are also related to postmyocardial infarction left ventricular function state.