| Failure of thrombolysis by streptokinase: detection with a simple electrocardiographic method. | |
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MedLine Citation:
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PMID: 10908249 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine whether simple, readily applicable ECG criteria will allow early prediction of inadequate (< TIMI 3) flow in the infarct related vessel in patients receiving thrombolytic treatment for acute myocardial infarction; and to determine the success of streptokinase in achieving adequate antegrade flow in the infarct related vessel two hours after starting treatment. DESIGN: Cohort study. SETTING: Regional cardiothoracic unit. PATIENTS: 100 sequential patients with acute myocardial infarction. INTERVENTIONS: Coronary angiography two hours after the initiation of thrombolytic treatment, proceeding to rescue angioplasty for inadequate flow in the infarct related vessel where appropriate. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of six ECG criteria for the detection of inadequate antegrade flow in the infarct related vessel. RESULTS: The ECG test that performed best as a positive test for < TIMI 3 flow in the infarct related vessel was < 50% resolution of the ST segment elevation in the worst lead and no accelerated idioventricular rhythm. This had a sensitivity of 81%, specificity of 88%, positive predictive value of 87%, negative predictive value of 83%, and overall accuracy of 85%. CONCLUSIONS: Sensitive, specific, and simple ECG criteria are defined for diagnosing failure of thrombolytic treatment with streptokinase. These allow the early detection of patients at high risk of further adverse events from a persistently occluded vessel. They may be used without recourse to sophisticated equipment or complex analyses. Such patients can then be considered for alternative treatments or enrollment into appropriate research protocols. |
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Authors:
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A G Sutton; P G Campbell; D J Price; E D Grech; J A Hall; A Davies; M J Stewart; M A de Belder |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 84 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2000 Aug |
Date Detail:
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Created Date: 2000-09-06 Completed Date: 2000-09-06 Revised Date: 2009-11-18 |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 149-56 Citation Subset: AIM; IM |
Affiliation:
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Cardiothoracic Division, South Cleveland Hospital, Middlesbrough, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Cohort Studies Electrocardiography* Female Fibrinolytic Agents / therapeutic use* Humans Male Middle Aged Myocardial Infarction / drug therapy*, physiopathology Predictive Value of Tests Sensitivity and Specificity Streptokinase / therapeutic use* Thrombolytic Therapy / methods* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.-/Streptokinase |
| Comments/Corrections | |
Comment In:
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Heart. 2000 Aug;84(2):113-5
[PMID:
10908231
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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