Accuracy of Post-thrombolysis ST-segment Reduction as an Adequate Reperfusion Predictor in the Pharmaco-Invasive...

Area of Science:

• Cardiology
• Interventional Cardiology
• Emergency Medicine

Background:

• Primary percutaneous coronary intervention is the standard for coronary reperfusion.
• Drug-invasive strategies using fibrinolysis are alternatives when PCI is unavailable.
• Electrocardiogram (ECG) monitoring is used to assess reperfusion success.

Purpose of the Study:

• To evaluate ST-segment changes on ECG after thrombolysis as a predictor of coronary recanalization.
• To compare ECG findings with angiographic outcomes using TIMI-flow and Myocardial Blush Grade (MBG) as criteria for ideal reperfusion.

Main Methods:

• Studied 2,215 ST-Segment Elevation Myocardial Infarction (STEMI) patients treated with Tenecteplase (TNK) fibrinolysis.
• ECGs were recorded before and 60 minutes after TNK administration.
• Patients were classified based on angiographic reperfusion (TIMI-3/MBG-3) versus inadequate reperfusion (TIMI/MBG <3).
• ECG reperfusion was defined as ST-segment reduction >50%.

Main Results:

• The ECG reperfusion criterion demonstrated a sensitivity of 79% and specificity of 40%.
• Positive predictive value was 56%, and negative predictive value was 66%.
• A weak positive correlation (r=0.21) was found between ST-segment reduction and ideal angiographic reperfusion, with low diagnostic accuracy (AUC=0.60).

Conclusions:

• ST-segment reduction on ECG is insufficient for accurately identifying adequate angiographic reperfusion.
• Angiography is crucial for confirming both macro- and microvascular coronary flow, even with seemingly successful reperfusion on ECG.