Failure of Simple Clinical Measurements to Predict Perfusion Status after Intravenous Thrombolysis

Califf, Robert M.; O'Neil, W.W.; Stack, Richard S.; Aronson, Lynne; Mark, Daniel B.; Mantell, Susan; George, Barry S.; Candela, Richard J.; Kereiakes, Dean J.; Abbottsmith, Charles W.; Topol, Eric J.; O’Neill, William W.; Walton, Joseph A.; Bates, Eric R.; Ellis, Stephen G.; Bourdillon, Patrick D.V.; Schork, M. Anthony; Kline, Eva M.

doi:10.7326/0003-4819-108-5-658

Cited by 240 publications

(47 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5 However, in several trials using these criteria, predictability of reperfusion often proved insufficient. 16 As reported by Laperche et al, 3 predictability of patency of the infarct-related artery could be enhanced by combining clinical criteria with some biochemical markers.…”

Section: Discussionmentioning

confidence: 75%

Myoglobin—A marker of reperfusion and a prognostic indicator in patients with acute myocardial infarction

Iqbal

Kazmi

Mehboobali

et al. 2004

Clinical Cardiology

View full text Add to dashboard Cite

SummaryBackground: Early noninvasive identification of patients with occluded infarct-related arteries after thrombolysis has important prognostic and therapeutic implications. Recent reports indicate that plasma kinetics of cardiac marker proteins could be very useful in diagnosis of myocardial reperfusion. Although angiographic assessment remains the ideal procedure for determining patency, it is expensive, invasive, not within the reach of most patients in developing countries, and the long-term follow-up data are still sparse.Hypothesis: The present study was undertaken to investigate whether plasma kinetics of myoglobin in conjunction with clinical markers and another biochemical marker, creatine kinase, could be used to predict myocardial reperfusion more accurately and to investigate the correlation between myoglobin release after thrombolysis and mortality in patients with acute myocardial infarction (AMI) over a follow-up period of 18 months.Methods: Eighty-three consecutive patients with AMI receiving streptokinase treatment were studied for plasma kinetics of myoglobin in conjunction with clinical markers and creatine kinase to predict reperfusion and were followed for a period of 18 months.Results: Increased baseline mean ± standard deviation levels of myoglobin were observed among "nonresponders" to

show abstract

Section: Discussionmentioning

confidence: 75%

Myoglobin—A marker of reperfusion and a prognostic indicator in patients with acute myocardial infarction

Iqbal

Kazmi

Mehboobali

et al. 2004

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…2 Some prior studies showed that arrhythmias, such as an accelerated idioventricular rhythm, were documented in many patients, whether reperfusion occurred or not, which suggests that development of arrhythmia is not an accurate marker for evaluating coronary patency after thrombolysis. 1,25 Although several recent studies have evaluated combined noninvasive markers with better results, 4,26,27 they are of insufficient accuracy to guide clinical decisions about rescue coronary angioplasty. 16 …”

Section: Comparison Of Mdct With Classical Noninvasive Predictors Formentioning

confidence: 99%

“…1 If the failure of reperfusion is identified early and accurately, in-hospital mortality after STEMI could be significantly reduced by implementing additional treatment, such as prompt rescue percutaneous angioplasty. 1,2 There are several noninvasive clinical predictors of failed reperfusion, such as improvement of chest pain, resolution of ST-segment elevation, washout of cardiac biomarkers and reperfusion arrhythmias; however, all of these markers have limitations for clinical decision making regarding additional invasive reperfusion therapy. [1][2][3][4] The recent introduction of the 16-slice multidetector row computed tomography (MDCT), with its high temporal resolution and increased gantry rotation, has enabled more accurate evaluation of the coronary tree.…”

mentioning

confidence: 99%

“…1,2 There are several noninvasive clinical predictors of failed reperfusion, such as improvement of chest pain, resolution of ST-segment elevation, washout of cardiac biomarkers and reperfusion arrhythmias; however, all of these markers have limitations for clinical decision making regarding additional invasive reperfusion therapy. [1][2][3][4] The recent introduction of the 16-slice multidetector row computed tomography (MDCT), with its high temporal resolution and increased gantry rotation, has enabled more accurate evaluation of the coronary tree. [5][6][7][8] Thus, MDCT is capable of not only detecting significant coronary stenosis or calcification, 6,7,[9][10][11] but also is useful for the evaluation of graft or stent patency, [12][13][14] as well as identification of anomalous coronary arteries.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Multidetector Row Computed Tomography Noninvasively Assesses Coronary Reperfusion After Thrombolytic Therapy in Patients With ST Elevation Myocardial Infarction

Shin¹,

Won²,

Chang³

et al. 2006

Circ J

View full text Add to dashboard Cite

BackgroundThe study objective was to assess the efficacy of 16-slice multidetector row computed tomography (MDCT) in estimating residual stenosis and successful reperfusion after thrombolysis in patients with ST-elevation myocardial infarction (STEMI). Methods and Results A total of 31 patients with STEMI underwent MDCT scanning within 6 h (mean 4.6± 1.1) after thrombolysis and the results for detection of significant residual stenosis and distal flow of the infarctrelated artery were compared with those from conventional coronary angiography (CCAG) performed within 24 h (mean 12.1±5.6) after the MDCT scan. Successful reperfusion was defined as Thrombolysis In Myocardial Infarction flow 2 or 3 on CCAG and full contrast enhancement of the distal artery landmarks on MDCT. A final analysis was performed using 24 patients (312 segments). MDCT had a positive predictive value of 73.3% and a negative predictive value of 95.1% for detecting significant residual stenosis. It accurately estimated 17 of 18 patients (94.4%) with successful reperfusion and 5 of 6 (83.3%) with failed reperfusion on the basis of comparison with CCAG. Conclusions MDCT demonstrated high accuracy not only for the detecting residual stenosis, but also for assessing successful reperfusion after thrombolytic therapy in patients with STEMI. (Circ J 2006; 70: 1590 -1597

show abstract

“…Chest pain resolution is not sufficiently accurate for decision making (33,34). Accelerated idioventricular rhythm is a relatively specific but insensitive predictor of patency (35).…”

Section: Clinical Assessment Of Reperfusionmentioning

confidence: 99%

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

Schnell

Kryski

Mann

et al. 2007

Canadian Journal of Cardiology

View full text Add to dashboard Cite

O ptimal therapy during acute myocardial infarction (AMI) includes prompt re-establishment of flow in the infarct-related artery (IRA) and effective reperfusion (1-3). Early, spontaneous reperfusion occurs in a small but significant proportion of IRAs (4,5), and the majority are reperfused with thrombolytic therapy. It is difficult to determine whether patency has been achieved at a given time in most patients without cardiac catheterization. The availability of a noninvasive method to rapidly assess myocardial perfusion has important implications in the emergency management of patients presenting with a known or suspected AMI, or after administration of a thrombolytic agent. However, no technique has yet been demonstrated to quickly and reliably predict the effectiveness of reperfusion or status of the IRA.Myocardial contrast echocardiography (MCE) uses an injection of microbubbles to assess myocardial perfusion. MCE can be used to reliably assess myocardial reperfusion following primary percutaneous coronary intervention (PCI) for AMI and to predict improvement in left ventricular (LV) function, as well as to assess the degree of collateral support to the infarcted territory (6-17). However, due to time constraints and the technical demands of OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven. METHODS: Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency. RESULTS: Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for nearnormal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001). CONCLUSIONS: MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a manag...

show abstract

Failure of Simple Clinical Measurements to Predict Perfusion Status after Intravenous Thrombolysis

Cited by 240 publications

References 18 publications

Myoglobin—A marker of reperfusion and a prognostic indicator in patients with acute myocardial infarction

Myoglobin—A marker of reperfusion and a prognostic indicator in patients with acute myocardial infarction

Multidetector Row Computed Tomography Noninvasively Assesses Coronary Reperfusion After Thrombolytic Therapy in Patients With ST Elevation Myocardial Infarction

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

Contact Info

Product

Resources

About