Quantitative ECG changes and patency of infarct-related arteries after intravenous streptokinase
J Gourassas1, J M Bennett, S Konstantinides
1Department of Internal Medicine, University of Pretoria.
Insights
Early electrocardiogram (ECG) changes can predict infarct-related artery patency in acute inferior myocardial infarction (MI) patients treated with streptokinase. Faster ST-segment elevation decline and early ST-segment depression indicate successful reperfusion.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Acute inferior myocardial infarction (MI) poses significant risks.
- Intravenous streptokinase is a common treatment for MI.
- Assessing infarct-related artery patency early is crucial for patient outcomes.
Purpose of the Study:
- To investigate the relationship between early electrocardiogram (ECG) changes and infarct-related artery patency in acute inferior MI patients.
- To identify specific ECG indices that may indicate successful reperfusion after streptokinase treatment.
Main Methods:
- Serial 12-lead ECGs were performed for 48 hours on 33 acute inferior MI patients treated with streptokinase.
- Measurements included ST-segment elevation (SumST), R wave amplitude (SumR), Q waves, and ST-segment depression (SumST (V1-V4]).
- ECG data was correlated with infarct-related artery patency determined by angiography.
Main Results:
- Patients with patent arteries showed a faster decline in SumST within 2.5 hours and reached a steady state earlier.
- A more pronounced decrease in SumST at 1.25 hours and a larger percentage drop in SumR at 4.5 hours were observed in patients with patent arteries.
- Early pronounced SumST (V1-V4) was noted in patent artery groups, though resolution times were similar to those with closed arteries.
Conclusions:
- Several early ECG indices, including ST-segment elevation and depression patterns, may reliably indicate infarct-related artery reperfusion in inferior MI.
- These ECG findings can aid in the early assessment of treatment effectiveness in acute MI.
Abstract:
Thirty-three patients with acute inferior myocardial infarction (MI), who were treated with intravenous streptokinase, were studied by serial 12-lead ECGs for 48 hours to determine the relationship between early changes in the sum of elevations above the baseline 40 ms after the end of the QRS complex in leads II, III and AFV (SumST), the sum of amplitude of R waves in leads II, III and AVF, the sum of the Q waves in leads II, III and AVF, the sum of ST-segment depression in leads V1-V4 as measured from the baseline to 80 ms after the J point (SumST (V1-V4] and the patency of the infarct-related artery at angiography after MI. Patients with patent arteries had a faster rate of decline in the SumST during the first 2.5 hours; reached the steady state earlier; had a more pronounced decrease in the SumST at 1.25 hours; a larger percentage drop in SumR at 4.5 hours and a more pronounced SumST (V1-V4) early on but resolution times similar to that of patients with closed arteries. Several ECG indices may indicate reperfusion of the infarct-related artery in patients with inferior MI.
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