1. ST Resolution 1 Hour After Fibrinolysis for Prediction of Myocardial Infarct Size: Insights from ASSENT 3
- Author
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Johanson, Per, Fu, Yuling, Wagner, Galen S., Goodman, Shaun G., Granger, Chris B., Wallentin, Lars, Van de Werf, Frans, and Armstrong, Paul W.
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MYOCARDIAL infarction , *FIBRINOLYSIS , *PERFUSION , *HEART necrosis , *HEALTH outcome assessment , *ELECTROCARDIOGRAPHY , *LEFT heart ventricle - Abstract
Acute ST-segment elevation myocardial infarction requires prompt restoration of myocardial perfusion to salvage myocardium at risk of ischemic necrosis and improve clinical outcome. Early resolution of ST-segment elevation during the time after reperfusion has been associated with both these end points. From the ASsessment of the Safety and Efficacy of a New Thrombolytic regimen (ASSENT) 3 trial, 3,425 patients were analyzed to investigate whether the amount of ST-segment resolution, divided into 3 groups (complete, >70%; partial, 30% to 70%; and no resolution, <30%), in the first hour after initiation of therapy was a predictor of final infarct size, estimated by peak creatine kinase and Selvester QRS score on the discharge electrocardiogram. Complete compared with partial and no ST resolution resulted in significantly (p <0.001) smaller infarct sizes of 10.5%, 13.2%, and 15.0% of the left ventricle and significantly (p = 0.001) fewer patients with peak creatine >5 times the upper reference level at 50.3%, 71.8%, and 76.3%, respectively. In conclusion, our findings supported previous smaller studies suggesting that early resolution of ST elevation, as a sign of early myocardial reperfusion, resulted in less myocardial damage and preservation of left ventricular function. [Copyright &y& Elsevier]
- Published
- 2009
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