Document Detail


Slowed ST segment recovery despite early infarct artery patency in patients with Q waves at presentation with a first acute myocardial infarction. Implications of initial Q waves on myocyte reperfusion.
MedLine Citation:
PMID:  12208225     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The presence of Q waves at presentation with a first acute myocardial infarction reflects a more advanced stage of the infarction process. When infarct-related artery patency (Thrombolysis in Myocardial Infarction 2 or 3 flow) is restored, resolution of ST segment elevation indicating successful myocyte reperfusion may differ according to how far the infarction process has progressed. METHODS AND RESULTS: In 144 patients with a first acute myocardial infarction treated with streptokinase in the first Hirulog Early Reperfusion Occlusion trial, information was obtained from continuous ST segment monitoring, the presenting electrocardiogram and early angiography performed at a median time of 99 min after the commencement of streptokinase (interquartile range 89-108 min). We determined how many patients had 50% ST recovery within 120 min and in how many cases it was sustained over 4h. In the 109 patients with patent infarct-related arteries, 50% ST recovery occurred in 95% of patients without vs 80% of those with initial Q waves (P=0.03), and sustained ST recovery occurred in 67% of patients without vs 47% of those with initial Q waves (P=0.03). On multivariate analysis including the time from symptom onset to streptokinase therapy, the presence of Q waves at presentation was the only predictor of failure to achieve 50% ST recovery (odds ratio 5.08, 95% confidence interval 1.29-20.01, P=0.02). TIMI 2 flow, as opposed to TIMI 3 flow, was the only predictor of failure to achieve stable ST recovery (odds ratio 2.63, 95% confidence interval 1.15-5.88,P =0.02). CONCLUSION: The presence of initial Q waves predicts slower and less complete ST recovery, reflecting reduced myocyte reperfusion, even in those with early infarct artery patency. These patients may be targeted for new therapeutic strategies to improve microvascular reperfusion.
Authors:
C-K Wong; J K French; M W Krucoff; W Gao; P E Aylward; H D White
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Evaluation Studies; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  European heart journal     Volume:  23     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-04     Completed Date:  2002-11-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1449-55     Citation Subset:  IM    
Copyright Information:
Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Affiliation:
Cardiovascular Research Unit, Green Lane Hospital, Epsom, Auckland, New Zealand.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Anticoagulants / therapeutic use
Aspirin / therapeutic use
Coronary Angiography
Coronary Circulation / drug effects
Double-Blind Method
Electrocardiography / drug effects*
Endpoint Determination
Female
Fibrinolytic Agents / therapeutic use
Heparin / therapeutic use
Hirudins / analogs & derivatives*
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / drug therapy*
Myocardial Reperfusion / methods*
Peptide Fragments / therapeutic use
Predictive Value of Tests
Prospective Studies
Recombinant Proteins / therapeutic use
Streptokinase / therapeutic use
Thrombolytic Therapy / methods
Vascular Patency / drug effects*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Hirudins; 0/Peptide Fragments; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 50-78-2/Aspirin; 9005-49-6/Heparin; EC 3.4.-/Streptokinase

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