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Relation of coronary arterial patency and left ventricular function to electrocardiographic changes after
S G Richardson1, P Morton, J G Murtagh
1Cardiac Unit, Belfast City Hospital, Northern Ireland.
Insights
Abrupt electrocardiographic changes after streptokinase treatment predict open coronary arteries in myocardial infarction patients. However, their absence does not reliably indicate occlusion, necessitating further diagnostic procedures.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Acute myocardial infarction (MI) requires timely reperfusion therapy.
- Streptokinase is a common thrombolytic agent used in MI treatment.
- Assessing infarct-related artery patency is crucial for patient management.
Purpose of the Study:
- To evaluate the predictive value of abrupt electrocardiographic repolarization changes for coronary artery patency after streptokinase treatment in acute MI.
- To determine if electrocardiographic changes correlate with left ventricular function post-treatment.
Main Methods:
- 188 patients with acute MI received intravenous streptokinase.
- Serial 12-lead electrocardiograms were recorded for 3 hours post-treatment.
- Electrocardiograms were analyzed for abrupt ST segment and T wave repolarization changes.
Main Results:
- Abrupt repolarization changes occurred in 56% of patients, strongly predicting an open infarct-related artery (predictive value=0.92).
- Absence of these changes (44% of patients) was a poor predictor of coronary artery occlusion (predictive value=0.4).
- No significant relation was found between electrocardiographic changes and left ventricular function.
Conclusions:
- Abrupt repolarization changes on ECG after thrombolysis suggest a high likelihood of a patent infarct-related artery.
- The absence of these ECG changes does not accurately predict coronary artery occlusion.
- Serial ECG monitoring alone is insufficient to rule out the need for coronary arteriography.
Abstract:
One hundred and eighty-eight patients with evolving acute myocardial infarction were treated with intravenous streptokinase. Serial 12-lead electrocardiograms were recorded for 3 hours after treatment and inspected for rapid repolarization changes of the ST segment and T wave. Abrupt electrocardiographic repolarization changes were observed in 106 patients (56%) and were strongly predictive for an open infarct-related coronary artery at a mean of 6 days after treatment (predictive value = 0.92, sensitivity = 0.67). Abrupt electrocardiographic changes were not observed in 82 patients (44%). This absence was not a good predictor of an occluded infarct-related coronary artery (predictive value = 0.4). There was no relation between the presence or absence of abrupt electrocardiographic changes and global or regional left ventricular function after streptokinase treatment. Abrupt repolarization changes after thrombolytic treatment indicate a high probability of an open infarct-related artery. When abrupt repolarization changes do not occur, the patency of the infarct-related coronary artery cannot be predicted with accuracy. Serial electrocardiographic recordings do not provide sufficient information about coronary patency to eliminate the need for coronary arteriography.