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Published on: May 28, 2019
Additional ST-segment elevation during thrombolytic therapy in patients with acute ST-elevation myocardial
Wolfgang Schreiber1, Harald Kittler, Harald Herkner
1Department of Emergency Medicine, University of Vienna, Austria. wolfgang.schreiber@akh-wien.ac.at
Insights
Additional ST-segment elevation during thrombolytic therapy indicates poorer outcomes in acute myocardial infarction (MI) patients. This electrocardiographic pattern is linked to reduced myocardial salvage and larger final infarct size, suggesting less effective treatment.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomedical Engineering
Background:
- Thrombolytic therapy is a cornerstone in managing acute myocardial infarction (MI).
- Electrocardiographic (ECG) changes during treatment can provide prognostic information.
- The significance of additional ST-segment elevation during thrombolysis requires further elucidation.
Purpose of the Study:
- To investigate the clinical significance of additional ST-segment elevation during thrombolytic therapy in patients with first acute myocardial infarction (MI).
- To correlate this ECG pattern with infarct size, myocardial salvage, and left ventricular function.
Main Methods:
- A cohort of 153 patients with first acute MI receiving thrombolytic therapy was divided into two groups: Group A (n=55) with additional ST-segment elevation ≥ 1 mm and Group B (n=98) without.
- Infarct size was estimated using ST-predicted and QRS-score methods.
- Cardiac enzyme levels (CK and CK-MB) and left ventricular function were assessed.
- Coronary angiography was performed to evaluate coronary artery disease.
Main Results:
- Group A patients, particularly those with anterior MI, showed no reduction in infarct size and larger final infarct size compared to Group B.
- For inferior MI patients, Group A had smaller myocardial salvage and larger final infarct size.
- Higher areas under the curve (AUC) for CK and CK-MB were observed in Group A, indicating greater myocardial damage.
- Group B demonstrated better global left ventricular function and ST-segment elevation resolution.
- Two and three-vessel coronary artery disease was more prevalent in Group A.
Conclusions:
- Additional ST-segment elevation during thrombolytic therapy is associated with reduced myocardial salvage and larger final infarct size.
- This ECG finding may indicate less effective reperfusion and salvage of myocardial tissue.
- Patients exhibiting this pattern may benefit from closer monitoring and potentially alternative reperfusion strategies.
Abstract:
The aim of the study was to investigate the clinical significance of additional ST-segment elevation that occurs during thrombolytic therapy. Therefore, we classified 153 patients with a first acute myocardial infarction (MI) into two groups: Group A, 55 patients with additional ST-segment elevation > or = 1 mm above the initial ST elevation during thrombolytic therapy and Group B, 98 patients without this electrocardiographic pattern. Among the patients with anterior MI, Group A (n = 33) had no reduction from ST-predicted to final QRS-estimated infarct size (+12% versus -27%; p = 0.0005) and a larger final infarct size (QRS-score: 18% versus 12%; p = 0.0002) than Group B (n = 41). Among the patients with inferior MI, Group A (n = 22) had a smaller reduction from ST-predicted to final QRS-estimated infarct size (-30% versus -53%; p = 0.03) and a larger final infarct size (QRS-score: 15% versus 9%; p = 0.03) than Group B (n = 57). The area under the curve (AUC) of CK and CK-MB was higher in patients from Group A compared with those from Group B (anterior MI: AUC-CK: 22,048 versus 19,490 U.h.l-1; p = 0.07; AUC-MB: 2227 versus 2016 U.h.l-1; p = 0.11; inferior MI: AUC-CK: 17,206 versus 11,004 U.h.l-1; p = 0.01; AUC-MB: 2193 versus 1046 U.h.l-1; p = 0.007). Both global left ventricular function and ST-segment elevation resolution were significantly better in Group B. Two and three vessel disease was observed more frequently in Group A. Additional ST-segment elevation during thrombolytic therapy suggests reduced myocardial salvage by thrombolytic therapy and thus may result in larger final infarct size.
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