Resolution of ST-segment elevation after streptokinase therapy in anterior versus inferior wall myocardial infarction.

Abstract

BACKGROUND:

Resolution of ST-segment elevation is the best bedside predictor of myocardial reperfusion.

HYPOTHESIS:

This study was conducted to examine the resolution of ST-segment elevation after streptokinase therapy in anterior versus inferior acute myocardial infarction (MI) and to corroborate it with echocardiographic and coronary angiographic data.

METHODS:

The study population consisted of 70 patients, 35 each in the anterior and inferior MI groups. The electrocardiograms (ECGs) were recorded before, on completion of, and on Days 1 and 2 post streptokinase therapy. The resolution of ST segment determined from post-streptokinase ECGs was compared between the two groups and correlated with echocardiographic and coronary angiographic data.

RESULTS:

On completion of and on Day 1 post streptokinase therapy, ST-segment resolution in both groups was not significantly different. On Day 2 post streptokinase therapy, resolution of the ST segment per lead was significantly lower in anterior than that in inferior MI (61 +/- 21% anterior vs. 77 +/- 21% inferior, p 0.003). The number of patients with akinesis of infarct-related ventricular wall was significantly higher (17 anterior vs. 7 inferior, p 0.02), and left ventricular ejection fraction was significantly lower in anterior MI (39 +/- 7% anterior vs. 48 +/- 8% inferior, p < 0.01). There was no significant difference in coronary angiographic data. One patient in each group demonstrated normal coronary arteries.

CONCLUSIONS:

The resolution of ST-segment elevation on the completion of and on Day 1 post streptokinase therapy was comparable between anterior and inferior MI. The significantly less frequent resolution of ST-segment elevation in anterior MI on Day 2 post streptokinase could be due to more akinesis, larger infarct size, and worse systolic function rather than due to failure to open the infarct-related vessel.

• Authors: E Guzman, I A Khan, S I Rahmatullah, C Verghese, K S Yi, A P Niarchos, A W Ansari, R A Cohen
• Journal: Clinical cardiology (Clin Cardiol) Vol. 23 Issue 7 Pg. 490-4 (Jul 2000) ISSN: 0160-9289 [Print] United States
• PMID: 10894436 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Streptokinase
• Plasminogen Activators

Topics

• Coronary Angiography
• Echocardiography
• Electrocardiography (drug effects)
• Female
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Myocardial Contraction (drug effects)
• Myocardial Infarction (diagnosis, drug therapy, physiopathology)
• Plasminogen Activators (administration & dosage, therapeutic use)
• Recovery of Function (drug effects)
• Retrospective Studies
• Streptokinase (administration & dosage, therapeutic use)
• Stroke Volume (drug effects)