Document Detail

Dependence of assessment of coronary artery reperfusion during acute myocardial infarction on angiographic criteria and interobserver variability.
MedLine Citation:
PMID:  3046294     Owner:  NLM     Status:  MEDLINE    
The angiographic films of 240 patients with acute myocardial infarction were studied in a randomized trial of intravenous anisoylated plasminogen streptokinase activator complex (APSAC) versus intracoronary streptokinase therapies. The interobserver variability of grading coronary artery perfusion by the Thrombolysis in Myocardial Infarction Study Group (TIMI) criteria was measured as well as the effect of different definitions of reperfusion on the determination of reperfusion rate. There was good agreement in the reading of infarct artery flow grades between 2 blinded observers for each grade considered separately (k = 0.726 +/- 0.014) and for grades 0 or 1 (no perfusion) versus grades 2 or 3 (perfusion) (k = 0.905 +/- 0.011). Discordance between grades 0 or 1 versus 2 or 3 occurred in 74 (5%) of the 1,615 angiographic readings. Discrepancies of clinical significance which affected qualification for study entry, reperfusion or reocclusion status occurred in only 15 patients (6%). Grade 1 flow was found to have the most variable interpretation. Reperfusion rates for APSAC and streptokinase differed significantly when reperfusion was defined by 3 different criteria. The reperfusion rate ranged from 51 to 72% for APSAC and from 60 to 75% for streptokinase depending upon criteria selected. For comparison of the results of different thrombolytic studies, a standard semiquantitative system for grading infarct artery perfusion should be used, readings should be blinded and the criteria used for the definition of reperfusion should be clearly specified.
R A Hackworthy; S G Sorensen; P G Fitzpatrick; W H Barry; R L Menlove; R L Rothbard; J L Anderson
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  62     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1988 Sep 
Date Detail:
Created Date:  1988-10-11     Completed Date:  1988-10-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  538-42     Citation Subset:  AIM; IM    
University of Utah, Salt Lake City.
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MeSH Terms
Clinical Trials as Topic
Coronary Angiography*
Coronary Circulation*
Coronary Thrombosis / drug therapy,  physiopathology,  radiography
Coronary Vessels / physiopathology
Infusions, Intravenous
Myocardial Infarction / drug therapy,  physiopathology*,  radiography
Plasminogen / administration & dosage
Random Allocation
Streptokinase / administration & dosage
Reg. No./Substance:
81669-57-0/Anistreplase; 9001-91-6/Plasminogen; EC 3.4.-/Streptokinase

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