Bedside markers of coronary artery patency and short-term prognosis of patients with acute myocardial infarction and thrombolysis
Keywords: sensitivity, systems, tests, heart, therapy, intravenous, mortality, blood, risk, infarction, disease, specificity, humans, artery, pain, human, male, agents, aged, prognosis, outcome, wave, reperfusion, adult, female, streptokinase, drug, article, kinase, elevation, coronary, marker, acute, lysis, segment, assessment, vascular, clinical, value, study, creatine, thorax, priority, middle, of, administration, journal, major, and, clot, t, Predictive, Myocardial, patency, fibrinolytic, Thrombolytic, (Health, Care), ST, Point-of-Care
Background: In this study we have evaluated the prognostic power of noninvasive markers of coronary artery reperfusion in patients with acute myocardial infarction who were treated with intravenous streptokinase. Methods: In 967 consecutive patients with acute myocardial infarction who were treated within 6 hours of symptoms, we analyzed the prognostic power of resolution of chest pain and ST-segment elevation >50% at 90 minutes, abrupt creatine kinase rise before 12 hours, and T-wave inversion in infarct-related electrocardiographic leads within the first 24 hours after thrombolysis. Results: Global in-hospital mortality rate was 12.0%. Each reperfusion marker was associated with improved outcome. Multivariate logistic regression analysis showed that 3 of the 4 markers of coronary artery reperfusion were significantly and independently associated to low in-hospital mortality rate. The presence of early T-wave inversion was associated with the lowest in- hospital mortality rate (odds ratio 0.25, confidence interval 0.10-0.56). When all markers of coronary artery reperfusion were included in the regression model, T-wave inversion (odds ratio 0.29, confidence interval 0.11-0.68) and abrupt creatine kinase rise (odds ratio 0.36, confidence interval 0.16-0.77) continued to be significantly associated with better outcome. Conclusion: A systemic analysis of noninvasive markers of coronary artery reperfusion can provide the clinician with an excellent tool to predict clinical outcomes when treating myocardial infarction.
|Título de la Revista:||AMERICAN HEART JOURNAL|
|Editorial:||MOSBY-YEAR BOOK INC|
|Fecha de publicación:||1999|
|Página de inicio:||533|