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European Heart Journal 2001 22(9):769-775; doi:10.1053/euhj.2000.2290
Copyright © 2001 by the European Society of Cardiology.
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Non-invasive detection of early infarct vessel patency by resolution of ST-segment elevation in patients with thrombolysis for acute myocardial infarction. Results of the angiographic substudy of the Hirudin for Improvement of Thrombolysis (HIT)-4 trial

U Zeymera,f1, R Schröderb, U Tebbec, G.P Molhoekd, K Wegscheiderb and K.-L Neuhausa

a Medizinische Klinik II, Klinikum Kassel, Kassel, Germany
b Universitätsklinikum Benjamin Franklin, Berlin, Germany
c Medizinische Klinik II, Klinikum Lippe-Detmold, Detmold, Germany
d Cardiology Research, Medisch Spectrum Enschede, Twente, The Netherlands

revised May 22, 2000; accepted May 24, 2000

Abstract

Aims The purpose of this study was to validate ST segment resolution as a non-invasive marker for patency of the infarct-related artery 90min after the start of streptokinase therapy in patients with acute myocardial infarction.

Methods and Results In the HIT-4 angiographic substudy, 447 patients with acute myocardial infarction ≤6h received 1·5 million IU streptokinase. Angiograms of the infarct vessel were obtained after 90min and 12-lead ECGs at baseline and after 90min. The best cut-off points for a correct prediction of 90min infarct vessel patency (TIMI 2/3 flow) and complete patency (TIMI 3) were 30% ST resolution and 40% ST resolution, respectively (specificity 68% and 69%, sensitivity 76% and 75%). Prediction of infarct vessel patency by ST resolution in steps of 10% displayed a gradual increase in patency rates. Patients with ≥70% ST resolution (n=70) had a 92% probability of TIMI 2/3 flow, while <30% ST resolution (n=172) was associated with the absence of TIMI 3 flow in 84% of patients.

Conclusions Despite fairly good sensitivities and specificities the prediction of infarct vessel patency by ST resolution in the individual patient is limited. However, patients with ≥70% ST resolution are likely to have a patent infarct artery and <30% ST resolution predicts epicardial vessel occlusion or, since persistent ST elevation reflects the existing ischaemic myocardial injury, absence of myocardial perfusion.

Key Words: Acute myocardial infarction, thrombolysis, angiography, ST resolution

f1 Correspondence: Dr Uwe Zeymer, Klinikum Kassel, Medizinische Klinik II, Mönchebergstrasse 41-43, D-34125 Kassel, Federal Republic of Germany.

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