Document Detail


Early noninvasive identification of failed reperfusion after intravenous thrombolytic therapy in acute myocardial infarction.
MedLine Citation:
PMID:  9626826     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
J T Stewart; J K French; P Théroux; K Ramanathan; B C Solymoss; R Johnson; H D White
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  1998-06-26     Completed Date:  1998-06-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1499-505     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Green Lane Hospital, Auckland, New Zealand. Jims@ahsl.co.nz
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MeSH Terms
Descriptor/Qualifier:
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:
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

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