Thrombolytic therapy and indirect reperfusion signs in ST segment elevation myocardial infarction

Aubed Sherhan, Ahmed; Khatar Mousa, Alaa

	Thrombolytic therapy and indirect reperfusion signs in ST segment elevation myocardial infarction
journal of kerbala university
Article 1, Volume 7, Issue 2, 2011, Pages 71-80 PDF (0 K)
Authors
ahmed aubed sherhan; alaa khatar mousa
Abstract
OBJECTIVE: To study the value of some indirect reperfusion signs as markers of coronary artery patency in patients with acute myocardial infarction submitted for intravenous thrombolytic therapy. DESIGN: A cross sectional study, with analysis of the predictive value (PV) of four indirect reperfusion signs (IRS): 1-chest Pain 2-ST segment resolution in the first three hours; 2. Peak CK in 4-6 hours; 3. Cardiac arrhythmia in the first three hours.post thrombolytic therapy SETTING: Coronary Care Unit of the AL-Mawani Hospital in Basrah(south of Iraq) Methods : 200 Patients with ST segment elevation myocardial infarction (STEMI) were studied between June 2009 and August 2010, their ages ranged between 38-74 year(mean age 53.4+/- 10.6 years) 156 males and 44females , 122 with anterior infarction and 78 with inferior infarction. All patients received Intravenous thrombolytic agent, followed by oral 300 mg acetilsalicylic acid, and IV heparin therapy with continuous electrocardiographic monitoring. The indirect reperfusion signs were recorded which include ST segment reduction by 50% or more recorded at the start and 30, 60,90 minutes and 3 hours of thrombolytic therapy , reperfusion arrhythmia ,elevation of Cardiac enzyme the relief of chest pain , RESULTS: The response to thrombolytic therapy in STEMI was much better as the patients received the therapy in the early periods (0-6 hours) than the later periods (more than 6 hours). One or more of the IRS were present in 156( 78%) patients with STEMI; the relieve of chest pain and ECG ST segment decrement in elevation were more frequent than elevation of cardiac enzymes and reperfusion arrhythmia . there was no difference in response to thrombolytic therapy with regard to location of myocardial infarction whether anterior or inferior . CONCLUSIONS: patients with STEMI should receive thrombolytic therapy as early as possible in order to get better reperfusion to save the myocardium. The analysis of IRS are useful to assess the successful of thrombolytic therapy especially in areas where the coronary angiography is not available.

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