Prediction of infarct coronary artery recanalization after intravenous thrombolytic therapy |
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| Authors: | B J Kircher E J Topol W W O'Neill B Pitt |
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| Affiliation: | 1. Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY;2. Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY;1. School of Medicine, New York Medical College, Valhalla, NY 10595, United States of America;2. Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America;3. Department of Neurology, PRISMA Health – Midlands/University of South Carolina School of Medicine, Columbia, SC 29203, United States of America;4. Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America;5. Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87106, United States of America;1. School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia;2. Central Analytical Research Facility, Queensland University of Technology, Brisbane, QLD, Australia;3. ProCan, Children''s Medical Research Institute, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia.;1. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA;2. Third Medicine Division, ASST Spedali Civili, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy;3. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy;4. IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy;5. Department Cardiology, Amsterdam UMC, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands;6. Heart Institute, University of São Paulo Medical School, São Paulo, Brazil;7. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark;8. Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany;9. Department of Cardiology, Odense University Hospital, Odense, Denmark;10. Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA;11. Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany;12. Berlin Institute of Health (BIH), Berlin, Germany;13. German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany;14. Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto, Kamakura, Japan;15. Radboud University Medical Center, Nijmegen, Netherlands;p. Department of Medical and Surgical Sciences, University of Sassari, Sassari, Italy |
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| Abstract: | Clinical assessment of patients with evolving acute myocardial infarction may suggest recanalization of the infarct coronary artery if chest pain, electrocardiographic ST-segment elevation and reperfusion arrhythmia are diminished. These 3 criteria, however, have not been correlated with immediate coronary angiography. Determination of which patients will achieve myocardial reperfusion after intravenous fibrinolytic therapy would allow for appropriate triage; those in whom it fails may be considered for mechanical or surgical recanalization. Fifty-six patients were studied: 28 received intravenous streptokinase and 28 intravenous recombinant tissue-type plasminogen activator. None of these clinical criteria, considered separately, was predictive of infarct artery recanalization status. Using the presence or absence of all 3 criteria, the specificity and predictive value increased to 100%. However, only 9% of patients in the series had all 3 criteria present (all had a patent infarct artery) and 34% had no criteria present (all had an occluded vessel). Noninvasive clinical markers are simple and practical, but only concordance of all 3 major criteria, when present, accurately predicts results of thrombolytic therapy. |
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