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European Heart Journal 1999 20(21):1563-1571; doi:10.1053/euhj.1999.1664
Copyright © 1999 by the European Society of Cardiology.
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Comparison of the predictive value of ST segment elevation resolution at 90 and 180min after start of streptokinase in acute myocardial infarction. A substudy of the Hirudin for Improvement of Thrombolysis (HIT)-4 Study

R Schrödera,f1, U Zeymerb, K Wegscheidera and K.L Neuhausb

a The Co-ordinating Centre of the HIT-4 Trial, Kassel and Berlin, Germany
b Städtische Kliniken, Kassel, Germany

Received March 16, 1999; accepted April 14, 1999

Abstract

Aims Previous studies revealed that ≥70% or <30% ST segment elevation resolution 180min after the start of thrombolysis is a strong predictor of either favourable or poor outcome. The aim of this study was to compare the prognostic value of ST segment elevation resolution at 90 and 180min after the start of streptokinase infusion

Methods and Results The Hirudin for Improvement of Thrombolysis (HIT)-4 study of 1208 patients compared streptokinase therapy in conjunction with either r-hirudin or heparin. Complete ST segment elevation resolution (≥70%) at 90 and 180min identified 25% and 50%, respectively, of all patients with a 30 day cardiac mortality of less than 2%. Forty-four percent of patients had no ST segment elevation resolution (<30%) at 90min and the 30 day cardiac mortality was 7·3%. At 180min, the no ST segment elevation resolution group decreased to 15% of all patients while the mortality risk increased to 13·6%.

Conclusions ST segment elevation resolution is a useful tool for early risk stratification and the strategy of rescue angioplasty. Complete ST segment elevation resolution within 180min of the start of streptokinase therapy indicates excellent survival prospects in 50% of patients. A half of these low risk patients can be identified at 90min. A high risk group appears to be best characterized by no ST segment elevation resolution at 180min rather than at 90min.

Key Words: Acute myocardial infarction, prognosis, ST resolution at 90min, ST resolution at 180min

f1 Correspondence: Prof. Dr Med. Rolf Schröder, Universitätsklinikum Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany.

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