Bedside markers of coronary artery patency and short-term prognosis of patients with acute myocardial infarction and thrombolysis

• Published in: The American heart journal Vol. 138; no. 3; pp. 533 - 539
• Main Authors: Corbalán, Ramón, Prieto, Juan C., Chavez, Eduardo, Nazzal, Carolina, Cumsille, Francisco, Krucoff, Mitchell
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-09-1999; Elsevier
• Subjects: Aged; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Female; Fibrinolytic Agents - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - pathology; Myocardial Reperfusion; Outcome Assessment (Health Care); Pharmacology. Drug treatments; Point-of-Care Systems; Predictive Value of Tests; Prognosis; Sensitivity and Specificity; Streptokinase - therapeutic use; Thrombolytic Therapy; Vascular Patency; Human; Prognosis; Infarct; Enzyme; Creatine kinase; Transferases; Treatment efficiency; Coronary artery; ST interval; Biological marker; Cardiovascular disease; Exploration; Coronary heart disease; Myocardial disease; Electrodiagnosis; Symptomatology; Chemotherapy; Treatment; T wave; Electrocardiography; Myocardium; Evolution; Repermeabilization; Fibrinolytic
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(99)70157-2

Background In this study we have evaluated the prognostic power of noninvasive markers of coronary artery reperfusion in patients with acute myocardial infarction who were treated with intravenous streptokinase.
Methods In 967 consecutive patients with acute myocardial infarction who were treated within 6 hours of symptoms, we analyzed the prognostic power of resolution of chest pain and ST-segment elevation >50% at 90 minutes, abrupt creatine kinase rise before 12 hours, and T-wave inversion in infarct-related electrocardiographic leads within the first 24 hours after thrombolysis.
Results Global in-hospital mortality rate was 12.0%. Each reperfusion marker was associated with improved outcome. Multivariate logistic regression analysis showed that 3 of the 4 markers of coronary artery reperfusion were significantly and independently associated to low in-hospital mortality rate. The presence of early T-wave inversion was associated with the lowest in-hospital mortality rate (odds ratio 0.25, confidence interval 0.10-0.56). When all markers of coronary artery reperfusion were included in the regression model, T-wave inversion (odds ratio 0.29, confidence interval 0.11-0.68) and abrupt creatine kinase rise (odds ratio 0.36, confidence interval 0.16-0.77) continued to be significantly associated with better outcome.
Conclusion A systemic analysis of noninvasive markers of coronary artery reperfusion can provide the clinician with an excellent tool to predict clinical outcomes when treating myocardial infarction. (Am Heart J 1999;138:533-9.)