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. 1990 Oct;64(4):241–247. doi: 10.1136/hrt.64.4.241

Rapid resolution of ST elevation and prediction of clinical outcome in patients undergoing thrombolysis with alteplase (recombinant tissue-type plasminogen activator): results of the Israeli Study of Early Intervention in Myocardial Infarction.

G I Barbash 1, A Roth 1, H Hod 1, H I Miller 1, S Rath 1, Y Har-Zahav 1, M Modan 1, U Seligsohn 1, A Battler 1, E Kaplinsky 1, et al.
PMCID: PMC1024413  PMID: 2121199

Abstract

Alteplase (recombinant tissue-type plasminogen activator (rt-PA)) was infused within four hours of onset of symptoms in 286 patients with acute myocardial infarction. Delayed coronary angiography was performed 72 hours after admission with coronary angioplasty if indicated. Electrocardiographic monitoring was continuous during the first hour of treatment. The sum of the ST segment elevations (sigma ST) was calculated on electrocardiograms recorded at entry and an hour later. ST elevations resolved rapidly within one hour of treatment in 189 patients and persisted in 97 patients. Rapid resolution of ST elevation correlated with angiographic coronary patency as determined by coronary angiography 72 hours after admission. The patients with rapid resolution of sigma ST had significantly smaller infarcts and a better clinical outcome than the patients with persistent ST elevation. sigma ST values at entry and one hour after treatment had no additional independent predictive value. Rapid resolution of ST elevations in patients undergoing thrombolysis with alteplase was associated with a significantly smaller release of creatine kinase, better preservation of left ventricular function, lower morbidity, and less short and long term mortality. Rapid resolution of sigma ST elevation is an efficient indicator of clinical outcome in groups of patients with acute myocardial infarction undergoing thrombolysis with alteplase.

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Selected References

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  1. Anderson J. L., Marshall H. W., Bray B. E., Lutz J. R., Frederick P. R., Yanowitz F. G., Datz F. L., Klausner S. C., Hagan A. D. A randomized trial of intracoronary streptokinase in the treatment of acute myocardial infarction. N Engl J Med. 1983 Jun 2;308(22):1312–1318. doi: 10.1056/NEJM198306023082202. [DOI] [PubMed] [Google Scholar]
  2. Blanke H., Scherff F., Karsch K. R., Levine R. A., Smith H., Rentrop P. Electrocardiographic changes after streptokinase-induced recanalization in patients with acute left anterior descending artery obstruction. Circulation. 1983 Aug;68(2):406–412. doi: 10.1161/01.cir.68.2.406. [DOI] [PubMed] [Google Scholar]
  3. De Feyter P. J., van Eenige M. J., van der Wall E. E., Bezemer P. D., van Engelen C. L., Funke-Kupper A. J., Kerkkamp H. J., Visser F. C., Roos J. P. Effects of spontaneous and streptokinase-induced recanalization on left ventricular function after myocardial infarction. Circulation. 1983 May;67(5):1039–1044. doi: 10.1161/01.cir.67.5.1039. [DOI] [PubMed] [Google Scholar]
  4. Ganz W., Geft I., Shah P. K., Lew A. S., Rodriguez L., Weiss T., Maddahi J., Berman D. S., Charuzi Y., Swan H. J. Intravenous streptokinase in evolving acute myocardial infarction. Am J Cardiol. 1984 May 1;53(9):1209–1216. doi: 10.1016/0002-9149(84)90066-3. [DOI] [PubMed] [Google Scholar]
  5. Hogg K. J., Hornung R. S., Howie C. A., Hockings N., Dunn F. G., Hillis W. S. Electrocardiographic prediction of coronary artery patency after thrombolytic treatment in acute myocardial infarction: use of the ST segment as a non-invasive marker. Br Heart J. 1988 Oct;60(4):275–280. doi: 10.1136/hrt.60.4.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kennedy J. W., Ritchie J. L., Davis K. B., Stadius M. L., Maynard C., Fritz J. K. The western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. A 12-month follow-up report. N Engl J Med. 1985 Apr 25;312(17):1073–1078. doi: 10.1056/NEJM198504253121701. [DOI] [PubMed] [Google Scholar]
  7. Kircher B. J., Topol E. J., O'Neill W. W., Pitt B. Prediction of infarct coronary artery recanalization after intravenous thrombolytic therapy. Am J Cardiol. 1987 Mar 1;59(6):513–515. doi: 10.1016/0002-9149(87)91158-1. [DOI] [PubMed] [Google Scholar]
  8. Koren G., Weiss A. T., Hasin Y., Appelbaum D., Welber S., Rozenman Y., Lotan C., Mosseri M., Sapoznikov D., Luria M. H. Prevention of myocardial damage in acute myocardial ischemia by early treatment with intravenous streptokinase. N Engl J Med. 1985 Nov 28;313(22):1384–1389. doi: 10.1056/NEJM198511283132204. [DOI] [PubMed] [Google Scholar]
  9. Krucoff M. W., Green C. E., Satler L. F., Miller F. C., Pallas R. S., Kent K. M., Del Negro A. A., Pearle D. L., Fletcher R. D., Rackley C. E. Noninvasive detection of coronary artery patency using continuous ST-segment monitoring. Am J Cardiol. 1986 Apr 15;57(11):916–922. doi: 10.1016/0002-9149(86)90730-7. [DOI] [PubMed] [Google Scholar]
  10. Marder V. J., Sherry S. Thrombolytic therapy: current status (1). N Engl J Med. 1988 Jun 9;318(23):1512–1520. doi: 10.1056/NEJM198806093182306. [DOI] [PubMed] [Google Scholar]
  11. Mathey D. G., Kuck K. H., Tilsner V., Krebber H. J., Bleifeld W. Non surgical coronary artery recanalization in acute transmural myocardial infarction. Circulation. 1981 Mar;63(3):489–497. doi: 10.1161/01.cir.63.3.489. [DOI] [PubMed] [Google Scholar]
  12. Rentrop P., Blanke H., Karsch K. R., Kaiser H., Köstering H., Leitz K. Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation. 1981 Feb;63(2):307–317. doi: 10.1161/01.cir.63.2.307. [DOI] [PubMed] [Google Scholar]
  13. Simoons M. L., Arnold A. E., Betriu A., de Bono D. P., Col J., Dougherty F. C., von Essen R., Lambertz H., Lubsen J., Meier B. Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty. Lancet. 1988 Jan 30;1(8579):197–203. doi: 10.1016/s0140-6736(88)91062-8. [DOI] [PubMed] [Google Scholar]
  14. Spann J. F., Sherry S., Carabello B. A., Denenberg B. S., Mann R. H., McCann W. D., Gault J. H., Gentzler R. D., Belber A. D., Maurer A. H. Coronary thrombolysis by intravenous streptokinase in acute myocardial infarction: acute and follow-up studies. Am J Cardiol. 1984 Mar 1;53(6):655–661. doi: 10.1016/0002-9149(84)90380-1. [DOI] [PubMed] [Google Scholar]
  15. Topol E. J., Califf R. M., George B. S., Kereiakes D. J., Abbottsmith C. W., Candela R. J., Lee K. L., Pitt B., Stack R. S., O'Neill W. W. A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med. 1987 Sep 3;317(10):581–588. doi: 10.1056/NEJM198709033171001. [DOI] [PubMed] [Google Scholar]
  16. von Essen R., Schmidt W., Uebis R., Edelmann B., Effert S., Silny J., Rau G. Myocardial infarction and thrombolysis. Electrocardiographic short term and long term results using precordial mapping. Br Heart J. 1985 Jul;54(1):6–10. doi: 10.1136/hrt.54.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]

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