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European Heart Journal 1990 11(4):328-333;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

ECG evidence of limited myocardial infarction following coronary occlusion trated by early intravenous rt-PA infuslon

R. KELY, M. MCGUIRE, J. HEALEY, H. GIBBS and M. O'ROURKE

Medical Professoiral Unit, University of New South Wales, St. Vincent's Hospital Sydney, New South Wales, Australia

Received 23 January 1989; revised 31 July 1989; .

Address for correspondence: Michael F. O;Rourke, Medical Professorial Unit, St. Vincent's Hospital, Darlinghurst, NSW, 2010

Abstract

Serial 12-lead surface electrocardiograms (ECGs) were analysed in 110 patients with first evolving myocardial infarction entered in a double-blind placebo-controlled trial of intravenous rt-PA within 2.5 h (mean l.9±0.5 (SD)) of pain onset. ECG analysis was performed by two ‘blinded’ analysts. QRS scoring (by the modified Selvester method) was used as an index of myocardial necrosis. Patient results were analysed according to infarct location. There was no difference between the two treatment groups in ST-segment elevation or QRS score at entry or up to 24 h after symptom onset. However from 24 h, QRS score was lower in patients with anterior infarction given rt-PA than in those given placebo: 5.4±2.8 vs 7.7±4.1 (P=0.02) at 48 h; 4.7±3.2 vs 8.0±4.0 (P=0.01) at 4-10 days; and 4.6±3.9 vs 7-5±3-9 (P=0.01) at 21 days. For patients with inferior infarction, rt-PA treatment also resulted in a lower QRS score although this was not significantly different from the score of the placebo group (P=0.07). Comparison of QRS scores with ejection fraction measured from the contrast ventriculogram taken at 21 days showed a moderate correlation (r=0.46) in patients with anterior infarction but a poor correlation in patients with inferior infarction. These ECG results indicate that in evolving anterior myocardial infarction, there is limitation of infarct size from early rt-PA infusion

Key Words: Thrombolysis • Selvester score • infarct size • rt-PA • alteplase


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