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. 2001 Jan;85(1):104–112. doi: 10.1136/heart.85.1.104

Acute myocardial infarction: failed thrombolysis

M A de Belder
PMCID: PMC1729601  PMID: 11119477

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Figure 1:  .

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ECG diagnosis of successful thrombolysis. The baseline ECG before thrombolytic treatment shows significant ST elevation in the anterior leads, with maximal ST elevation of 7 mm in lead V3 80 ms after the J point (A). Two hours after the start of thrombolysis with streptokinase, the ST segments have reduced (B). Although the ST elevation in C3 is 2-3 mm, the fall in ST elevation from baseline is greater than 50% of the initial elevation. The patient was shown at angiography to have TIMI 3 flow in the left anterior descending artery (the infarct related vessel).             

Figure 2:  .

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ECG diagnosis of failed thrombolysis. The pre-thrombolysis ECG shows significant ST elevation, maximal at just over 4 mm in lead V3 (A). Two hours after the start of thrombolysis, there is no change in the ST elevation in this lead (B). The patient was shown to have an occluded left anterior descending artery at angiography just after the ECG was taken.

Figure 3:  .

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Theoretical considerations in evaluation of interventional treatment in acute myocardial infarction. The treatment will only be justified if the late benefit greatly exceeds early hazard. Currently, the areas between the curves and the time to crossover in relation to rescue angioplasty are unknown.

Figure 4:  .

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Results from three studies of rescue angioplasty: *TAMI-512; **RESCUE13; ***Vermeer et al.14 Combined end points: TAMI-5—death, stroke, reinfarction, reocclusion, heart failure or recurrent ischaemia during hospitalisation (rescue v conservative, p = 0.004); RESCUE—death or congestive failure at 30 days (rescue v conservative, p = 0.05); Vermeer et al—death or recurrent infarction within 42 days (comparison between groups, p = NS).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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