| Early noninvasive identification of failed reperfusion after intravenous thrombolytic therapy in acute myocardial infarction. | |
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MedLine Citation:
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PMID: 9626826 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 < or = 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 < or = 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. |
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Authors:
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J T Stewart; J K French; P Théroux; K Ramanathan; B C Solymoss; R Johnson; H D White |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 31 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1998 Jun |
Date Detail:
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Created Date: 1998-06-26 Completed Date: 1998-06-26 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1499-505 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Green Lane Hospital, Auckland, New Zealand. Jims@ahsl.co.nz |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Biological Markers Creatine Kinase / blood Female Fibrinolytic Agents / therapeutic use* Humans Isoenzymes Male Middle Aged Myocardial Infarction / drug therapy* Myocardial Reperfusion* Myoglobin / blood Predictive Value of Tests ROC Curve Sensitivity and Specificity Streptokinase / therapeutic use* Time Factors Treatment Failure Troponin / analysis Troponin T |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Fibrinolytic Agents; 0/Isoenzymes; 0/Myoglobin; 0/Troponin; 0/Troponin T; EC 2.7.3.2/Creatine Kinase; EC 3.4.-/Streptokinase |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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