(Circulation. 2000;101:2138.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
ST-Segment Recovery Adds to the Assessment of TIMI 2 and 3 Flow in Predicting Infarct Wall Motion After Thrombolytic Therapy
From the Department of Cardiology, Green Lane Hospital (J.A., I.T.S., J.K.F., M.L., H.D.W.), Auckland, New Zealand, and Duke Clinical Research Institute (C.L.G., A.C.P.M., M.W.K.), Durham, NC.
Correspondence to Dr John French, Department of Cardiology, Green Lane Hospital, Private Bag 92189, Auckland 1030, New Zealand. E-mail johnf{at}ahsl.co.nz
Background—Early resolution of ST-segment elevation (ST-segment recovery) is associated with an improved outcome after infarction. Whether this relation is present in patients with Thrombolysis In Myocardial Infarction (TIMI) grade 2 or 3 flow (ie, patent) infarct-related arteries is not known.
Methods and Results—To examine the associations between time to
achieve stable 50% ST-segment recovery assessed by continuous ECG
monitoring, infarct artery flow, and infarct zone wall motion (at 48
hours), we studied 134 patients who underwent angiography at 99
(interquartile range 92 to 110) minutes after commencing streptokinase,
initiated within 12 hours of onset of symptoms of myocardial
infarction. Patients with TIMI 2 or 3 flow who failed to achieve early
stable ST-segment recovery (50% ST-segment recovery sustained for 
4
hours with <100 µV change in the peak lead) by 60 or 90 minutes had
a higher fraction of chords in the infarct zone >2 SD below normal
wall motion (TIMI 2: 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 was a multivariate predictor of infarct zone
wall motion (P=0.04) independent of TIMI flow grade and
the time from symptom onset to streptokinase therapy.
Conclusions—In patients with TIMI 2 or 3 flow in infarct-related artery, early stable ST-segment recovery is associated with improved infarct zone wall motion at 48 hours. ST-segment recovery may provide additional information about the degree of myocyte reperfusion achieved in patients with a patent epicardial infarct-related artery after thrombolytic therapy.
Key Words: myocardial infarction • thrombolysis • reperfusion • myocytes • streptokinase
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