首页 | 本学科首页   官方微博 | 高级检索  
     


Early Noninvasive Identification of Failed Reperfusion After Intravenous Thrombolytic Therapy in Acute Myocardial Infarction
Authors:James T. Stewart MD, MRCP, John K. French PhD, FRACP, Pierre Th  roux MD, FRCP, FACC, Krishnan Ramanathan MB, B. Charles Solymoss MD, Roger Johnson PhD,Harvey D. White DSc, FRACP, FACC
Affiliation:James T. Stewart MD, MRCP, John K. French PhD, FRACP, Pierre Théroux MD, FRCP(C), FACC, Krishnan Ramanathan MB, B. Charles Solymoss MD, Roger Johnson PhD,Harvey D. White DSc, FRACP, FACC
Abstract:
Objectives. This study sought to evaluate a biochemical approach to the early noninvasive assessment of reperfusion.

Background. In patients with an acute myocardial infarction, a rapid noninvasive method of detecting failure of intravenous thrombolytic therapy to restore early Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in the infarct-related artery (IRA) is needed.

Methods. Serial blood samples were collected to assay creatine kinase-MB fraction (CKMB mass), cardiac troponin T and myoglobin concentrations in 105 patients with a myocardial infarction who underwent early angiography after intravenous streptokinase. The ratios of the 60- and 90-min concentrations to prethrombolytic values were used to determine an index that could identify failure to achieve TIMI grade 3 flow in the IRA at 90 min.

Results. Significant increases in serum concentrations of markers at 60 min were more likely with TIMI grade 3 flow (59 patients) than with TIMI grade 0 to 2 flow (46 patients). Ratios ≤5 at 60 min after thrombolysis detected failure to achieve 90-min TIMI grade 3 flow with 92% to 97% sensitivity, 43% to 60% specificity and 63% to 76% positive and 86% to 94% negative predictive values. Ratios ≤10 at 90 min showed 88% to 95% sensitivity, 49% to 65% specificity and 61% to 69% positive and 86% to 94% negative predictive values for TIMI flow grade <3. The overall predictive values were thus similar for all three markers.

Conclusions. In acute myocardial infarction treated with intravenous streptokinase, a simple measurement of increased serum concentrations of CKMB mass, cardiac troponin T or myoglobin at 60 and 90 min can accurately predict failure to achieve TIMI grade 3 flow in the IRA at 90 min.

Keywords:
本文献已被 ScienceDirect 等数据库收录!
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号