Failure of thrombolysis by streptokinase: detection with a simple electrocardiographic method.

Abstract

OBJECTIVE:

To determine whether simple, readily applicable ECG criteria will allow early prediction of inadequate (< TIMI 3) flow in the infarct related vessel in patients receiving thrombolytic treatment for acute myocardial infarction; and to determine the success of streptokinase in achieving adequate antegrade flow in the infarct related vessel two hours after starting treatment.

DESIGN:

Cohort study.

SETTING:

Regional cardiothoracic unit.

PATIENTS:

100 sequential patients with acute myocardial infarction.

INTERVENTIONS:

Coronary angiography two hours after the initiation of thrombolytic treatment, proceeding to rescue angioplasty for inadequate flow in the infarct related vessel where appropriate.

MAIN OUTCOME MEASURES:

Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of six ECG criteria for the detection of inadequate antegrade flow in the infarct related vessel.

RESULTS:

The ECG test that performed best as a positive test for < TIMI 3 flow in the infarct related vessel was < 50% resolution of the ST segment elevation in the worst lead and no accelerated idioventricular rhythm. This had a sensitivity of 81%, specificity of 88%, positive predictive value of 87%, negative predictive value of 83%, and overall accuracy of 85%.

CONCLUSIONS:

Sensitive, specific, and simple ECG criteria are defined for diagnosing failure of thrombolytic treatment with streptokinase. These allow the early detection of patients at high risk of further adverse events from a persistently occluded vessel. They may be used without recourse to sophisticated equipment or complex analyses. Such patients can then be considered for alternative treatments or enrollment into appropriate research protocols.

• Authors: A G Sutton, P G Campbell, D J Price, E D Grech, J A Hall, A Davies, M J Stewart, M A de Belder
• Journal: Heart (British Cardiac Society) (Heart) Vol. 84 Issue 2 Pg. 149-56 (Aug 2000) ISSN: 1468-201X [Electronic] England
• PMID: 10908249 (Publication Type: Journal Article)

Chemical References

• Fibrinolytic Agents
• Streptokinase

Topics

• Adult
• Aged
• Aged, 80 and over
• Cohort Studies
• Electrocardiography
• Female
• Fibrinolytic Agents (therapeutic use)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy, physiopathology)
• Predictive Value of Tests
• Sensitivity and Specificity
• Streptokinase (therapeutic use)
• Thrombolytic Therapy (methods)
• Treatment Outcome