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Failure of thrombolysis by streptokinase: detection with a simple electrocardiographic method
A G Sutton1, P G Campbell, D J Price
1Cardiothoracic Division, South Cleveland Hospital, Middlesbrough, UK.
Insights
Simple electrocardiogram (ECG) criteria can predict failed thrombolytic treatment in acute myocardial infarction patients. These criteria help identify individuals with inadequate blood flow, enabling timely alternative treatments.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Acute myocardial infarction (AMI) requires prompt restoration of blood flow.
- Thrombolytic therapy is a primary treatment, but its success varies.
- Early identification of treatment failure is crucial for patient outcomes.
Purpose of the Study:
- To evaluate simple electrocardiogram (ECG) criteria for early prediction of inadequate (< TIMI 3) coronary blood flow after thrombolysis for AMI.
- To assess the efficacy of streptokinase in achieving adequate antegrade flow two hours post-treatment.
Main Methods:
- A cohort study involving 100 sequential patients with AMI.
- Coronary angiography was performed two hours after initiating thrombolytic treatment.
- Six ECG criteria were analyzed for sensitivity, specificity, and accuracy in detecting inadequate vessel flow.
Main Results:
- The most effective ECG predictor of inadequate flow (< TIMI 3) was less than 50% ST-segment elevation resolution and absence of accelerated idioventricular rhythm.
- This combination demonstrated 81% sensitivity, 88% specificity, 87% positive predictive value, 83% negative predictive value, and 85% accuracy.
- Coronary angiography confirmed these findings, guiding rescue angioplasty when necessary.
Conclusions:
- Simple, sensitive, and specific ECG criteria can reliably diagnose failed streptokinase thrombolysis in AMI.
- These criteria facilitate early detection of patients at high risk due to persistent vessel occlusion.
- This allows for prompt consideration of alternative therapies or research protocols without complex analysis.
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.