Accuracy of Post-thrombolysis ST-segment Reduction as an Adequate Reperfusion Predictor in the Pharmaco-Invasive Approach

• Published in: Arquivos brasileiros de cardiologia Vol. 117; no. 1; pp. 15 - 25
• Main Authors: Bianco, Henrique Tria, Povoa, Rui, Izar, Maria Cristina, Luna Filho, Braulio, Moreira, Flavio Tocci, Stefanini, Edson, Fonseca, Henrique Andrade, Barbosa, Adriano Henrique Pereira, Alves, Claudia Maria Rodrigues, Caixeta, Adriano Mendes, Gonçalves, Iran, Moraes, Pedro Ivo de Marqui, Lopes, Renato Delascio, Paola, Angelo Amato Vincenzo de, Almeida, Dirceu, Moises, Valdir Ambrosio, Fonseca, Francisco A H
• Format: Journal Article
• Language: English; Portuguese
• Published: 01-01-2021
• ISSN: 1678-4170
• DOI: 10.36660/abc.20200241

BACKGROUNDPrimary percutaneous coronary intervention is considered the "gold standard" for coronary reperfusion. However, when not available, the drug-invasive strategy is an alternative method and the electrocardiogram (ECG) has been used to identify reperfusion success. OBJECTIVESOur study aimed to assess ST-Segment changes in post-thrombolysis and their power to predict recanalization and using the angiographic scores TIMI-flow and Myocardial Blush Grade (MBG) as an ideal reperfusion criterion. METHODS2,215 patients with ST-Segment Elevation Myocardial Infarction (STEMI) undergoing fibrinolysis [(Tenecteplase)-TNK] and referred to coronary angiography within 24 h post-fibrinolysis or immediately referred to rescue therapy were studied. The ECG was performed pre- and 60 min-post-TNK. The patients were categorized into 2 groups: those with ideal reperfusion (TIMI-3 and MBG-3) and those with inadequate reperfusion (TIMI and MBG <3). The ECG reperfusion criterion was defined by the reduction of the ST-Segment >50%. A p-value <0.05 was considered for the analyses, with bicaudal tests. RESULTSThe ECG reperfusion criterion showed a positive predictive value of 56%; negative predictive value of 66%; sensitivity of 79%; and specificity of 40%. There was a weak positive correlation between ST-Segment reduction and ideal reperfusion angiographic data (r = 0.21; p <0.001) and low diagnostic accuracy, with an AUC of 0.60 (95%CI: 0.57-0.62). CONCLUSIONThe ST-Segment reduction was not able to accurately identify patients with adequate angiographic reperfusion. Therefore, even patients with apparently successful reperfusion should be referred to angiography soon, to ensure adequate macro and microvascular coronary flow.