Relation of coronary arterial patency and left ventricular function to electrocardiographic changes after streptokinase treatment during acute myocardial infarction

Richardson, S G; Morton, P; Murtagh, J G; Scott, Michael; O’Keeffe, D. B.

doi:10.1016/0002-9149(88)90106-3

Cited by 37 publications

(8 citation statements)

References 16 publications

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“…Early T-wave inversion was associated with more frequent and greater adequate patency of the infarct-related artery. Our findings are similar to those of Richardson et al [6], who reported a significantly faster reduction of T wave amplitude, within 3 h after the initiation of thrombolytic therapy among patients with a patent infarct-related artery.…”

Section: Discussionsupporting

confidence: 92%

“…Successful thrombolytic therapy is associated with rapid resolution of ST segment and, in a substantial proportion of patients there is early and rapid development of new pathologic Q and R wave amplitude loss [5] . Although a great deal of attention has been paid to the significance of early changes in the ST segment after thrombolytic therapy [4] , little importance is given to early changes in the T wave [6] . Therefore the aim of this study was to investigate the relationship between early T-wave inversion after thrombolytic therapy and the likelihood of successful epicardial coronary reperfusion.…”

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confidence: 99%

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Early Changes in Ventricular Repolarization after Thrombolytic Therapy in Patients with Acute Myocardial Infarction as Indicators for Prediction of Epicardial Coronary Artery Reperfusion

Hegazy¹,

Abdulkader

Akbar

et al. 2007

Med Princ Pract

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Objectives: To investigate the relationship between early T-wave inversion after thrombolytic therapy and the likelihood of successful epicardial coronary reperfusion. Subjects and Methods: Thrombolytic therapy was given to 195 patients with ST segment elevation due to acute anterior myocardial infarction (AMI). Coronary angiography was performed. Receiver operating characteristic (ROC) curve (grade of sensitivity versus false positive) was calculated using likelihood ratio method to identify the ideal cut-off values of the ventricular repolarization variables. Results: Predictive indices showed 80% sensitivity, 83% specificity, 81% accuracy, 88% positive predictive value and 71% negative predictive value for early T-wave inversion after thrombolytic therapy. A good concordant agreement was noted between the data of coronary angiography and early T-wave inversion in the infarct-related ECG leads after thrombolysis (kappa coefficient ĸ= 0.876). Stepwise multivariate analysis revealed that early T-wave inversion after thrombolytic therapy of AMI was significantly associated with a history of preinfarction angina, residual infarct-related coronary artery stenosis >50%, short time to thrombolytic therapy <90 min, and evening time for occurrence of thrombolysis (p < 0.05). The ROC curve data analysis showed that early T-wave inversion amplitude after AMI had 87% sensitivity and 84% specificity for predicting successful reperfusion, with an ideal cut-off value of 7.2 mm, while time of T-wave inversion had 80% sensitivity and 79% specificity, with an ideal cut-off value of 120 min. Conclusion: The data indicate that early inversion of T wave after AMI is a statistically significant independent variable in predicting successful epicardial coronary thrombolysis status.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Early Changes in Ventricular Repolarization after Thrombolytic Therapy in Patients with Acute Myocardial Infarction as Indicators for Prediction of Epicardial Coronary Artery Reperfusion

Hegazy¹,

Abdulkader

Akbar

et al. 2007

Med Princ Pract

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“…[9][10][11] It seems logical that continuous ECG monitoring would be a superior technique to the recording of static ECGs, and this technique has been quite exhaustively investigated. [12][13][14][15][16] Veldkamp and colleagues reported that continuous ST segment monitoring was at least as accurate as the most accurate of a number of static electrocardiographic methods, 17 and Zabel and colleagues found that the use of two static ECGs before and two hours after thrombolytic treatment had the same predictive value as continuous Holter monitoring with respect to thrombolysis induced coronary artery reperfusion.…”

Section: Previously Described Ecg Criteria For Detection Of Failed Rementioning

confidence: 99%

Endomyocardial fibrosis associated with antiphospholipid syndrome

Azeem¹

2000

Heart

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Objective-To determine whether simple, readily applicable ECG criteria will allow early prediction of inadequate (< TIMI 3) flow in the infarct related vessel in patients receiving thrombolytic treatment for acute myocardial infarction; and to determine the success of streptokinase in achieving adequate antegrade flow in the infarct related vessel two hours after starting treatment. Design-Cohort study. Setting-Regional cardiothoracic unit. Patients-100 sequential patients with acute myocardial infarction. Interventions-Coronary angiography two hours after the initiation of thrombolytic treatment, proceeding to rescue angioplasty for inadequate flow in the infarct related vessel where appropriate. Main outcome measures-Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of six ECG criteria for the detection of inadequate antegrade flow in the infarct related vessel. Results-The ECG test that performed best as a positive test for < TIMI 3 flow in the infarct related vessel was < 50% resolution of the ST segment elevation in the worst lead and no accelerated idioventricular rhythm. This had a sensitivity of 81%, specificity of 88%, positive predictive value of 87%, negative predictive value of 83%, and overall accuracy of 85%. Conclusions-Sensitive, specific, and simple ECG criteria are defined for diagnosing failure of thrombolytic treatment with streptokinase. These allow the early detection of patients at high risk of further adverse events from a persistently occluded vessel. They may be used without recourse to sophisticated equipment or complex analyses. Such patients can then be considered for alternative treatments or enrolment into appropriate research protocols. (Heart 2000;84:149-156)

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“…Most have analyzed ST segment dynamics during the hyperacute phase of myocardial infarction as a marker of coronary reperfusion [18, 19, 20]. However, the ST segment and T waves reach a stable pattern only 7–10 days after the acute phase [11].…”

Section: Discussionmentioning

confidence: 99%

Correlation of Predischarge Electrocardiographic Patterns with Left Ventricular Function in Patients with Anterior Wall Myocardial Infarction

Porter¹,

Mazur²,

Solodky³

et al. 2000

Cardiology

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The aim of this prospective study was to assess the correlation between different predischarge electrocardiographic patterns and left ventricular function, evaluated by physical examination and echocardiography, in patients with first Q wave anterior acute myocardial infarction. A positive correlation was found between the electrocardiographic pattern and wall motion score assessed by echocardiography, reflecting a gradual worsening in left ventricular function among the different patterns. Patients with an isoelectric ST segment and negative T waves had a 73% decrease in the risk of clinical heart failure compared to those who continued to have ST elevation. Thus, a predischarge electrocardiogram can be used as a simple, noninvasive method for the risk stratification of patients with acute myocardial infarction.

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Relation of coronary arterial patency and left ventricular function to electrocardiographic changes after streptokinase treatment during acute myocardial infarction

Cited by 37 publications

References 16 publications

Early Changes in Ventricular Repolarization after Thrombolytic Therapy in Patients with Acute Myocardial Infarction as Indicators for Prediction of Epicardial Coronary Artery Reperfusion

Early Changes in Ventricular Repolarization after Thrombolytic Therapy in Patients with Acute Myocardial Infarction as Indicators for Prediction of Epicardial Coronary Artery Reperfusion

Endomyocardial fibrosis associated with antiphospholipid syndrome

Correlation of Predischarge Electrocardiographic Patterns with Left Ventricular Function in Patients with Anterior Wall Myocardial Infarction

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