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The relationship between grade of ischemia, success of reperfusion, and type of thrombolytic regimen.

Ayça B, Conkbayır C, Katkat F, Gulsen K, Akin F, Okuyan E, Baskurt M, Okcun B - Med. Sci. Monit. (2015)

Bottom Line: The success rate was lowest at anterior GI3 (55.8%).Although there was no significant difference between thrombolytic regimens in all groups (p=0.77), t-Pa was superior to SKZ in anterior GI3 (63,6% vs. 30%, p=0.061).Fibrin specific regime should be preferred in anterior GI3.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Bağcılar Education and Research Hospital, Bağcılar, Istanbul, Turkey.

ABSTRACT

Background: This study was aimed to determine whether the grade of ischemia can predict the success of reperfusion in patients treated with thrombolytic therapy (TT) for ST elevation myocardial infarction (STEMI).

Material and methods: We enrolled 229 consecutive patients with diagnosis of STEMI and receiving TT. Patients were divided into 2 groups--grade 2 ischemia (GI2) and grade 3 ischemia (GI3)--according to initial electrocardiogram (ECG). As TT, fibrin-specific (tissue plasminogen activator (t-PA)) or non-fibrin-specific (streptokinase (SKZ)) regimens were used. Successful reperfusion was defined as >50% resolution of the maximal ST segment on 90-min ECG. We tried to evaluate whether the grade of ischemia could predict the success of reperfusion and if there were any differences in terms of successful reperfusion between different thrombolytic regimens.

Results: The successful reperfusion rate was significantly higher in GI2 than GI3 (82.4% vs. 64.4% respectively, p=0.002). The success rate was lowest at anterior GI3 (55.8%). Although there was no significant difference between thrombolytic regimens in all groups (p=0.77), t-Pa was superior to SKZ in anterior GI3 (63,6% vs. 30%, p=0.061). In addition, in multivariate analysis, GI and infarct localization were found as independent predictors for successful reperfusion with TT (p=0.006 and p=0.042, respectively).

Conclusions: In the current study, we found that GI2 is an independent predictor for successful reperfusion in STEMI treated with TT. Fibrin specific regime should be preferred in anterior GI3.

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Example of GI1, GI2 and GI3 on electrocardiogram. GI: grade of ischemia.
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f1-medscimonit-21-716: Example of GI1, GI2 and GI3 on electrocardiogram. GI: grade of ischemia.

Mentions: The baseline ECGs were performed before TT were analyzed and classified as GI2 or GI3. In ECGs with GI3, QRS configuration was deformed – either lack of an S wave in >2 leads that have a terminal S wave (usually V1 to V3), or J point amplitude >50% of the R wave amplitude in 2 of all other leads [10]. ECGs not meeting GI3 criteria was defined as GI2 (Figure 1).


The relationship between grade of ischemia, success of reperfusion, and type of thrombolytic regimen.

Ayça B, Conkbayır C, Katkat F, Gulsen K, Akin F, Okuyan E, Baskurt M, Okcun B - Med. Sci. Monit. (2015)

Example of GI1, GI2 and GI3 on electrocardiogram. GI: grade of ischemia.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4362488&req=5

f1-medscimonit-21-716: Example of GI1, GI2 and GI3 on electrocardiogram. GI: grade of ischemia.
Mentions: The baseline ECGs were performed before TT were analyzed and classified as GI2 or GI3. In ECGs with GI3, QRS configuration was deformed – either lack of an S wave in >2 leads that have a terminal S wave (usually V1 to V3), or J point amplitude >50% of the R wave amplitude in 2 of all other leads [10]. ECGs not meeting GI3 criteria was defined as GI2 (Figure 1).

Bottom Line: The success rate was lowest at anterior GI3 (55.8%).Although there was no significant difference between thrombolytic regimens in all groups (p=0.77), t-Pa was superior to SKZ in anterior GI3 (63,6% vs. 30%, p=0.061).Fibrin specific regime should be preferred in anterior GI3.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Bağcılar Education and Research Hospital, Bağcılar, Istanbul, Turkey.

ABSTRACT

Background: This study was aimed to determine whether the grade of ischemia can predict the success of reperfusion in patients treated with thrombolytic therapy (TT) for ST elevation myocardial infarction (STEMI).

Material and methods: We enrolled 229 consecutive patients with diagnosis of STEMI and receiving TT. Patients were divided into 2 groups--grade 2 ischemia (GI2) and grade 3 ischemia (GI3)--according to initial electrocardiogram (ECG). As TT, fibrin-specific (tissue plasminogen activator (t-PA)) or non-fibrin-specific (streptokinase (SKZ)) regimens were used. Successful reperfusion was defined as >50% resolution of the maximal ST segment on 90-min ECG. We tried to evaluate whether the grade of ischemia could predict the success of reperfusion and if there were any differences in terms of successful reperfusion between different thrombolytic regimens.

Results: The successful reperfusion rate was significantly higher in GI2 than GI3 (82.4% vs. 64.4% respectively, p=0.002). The success rate was lowest at anterior GI3 (55.8%). Although there was no significant difference between thrombolytic regimens in all groups (p=0.77), t-Pa was superior to SKZ in anterior GI3 (63,6% vs. 30%, p=0.061). In addition, in multivariate analysis, GI and infarct localization were found as independent predictors for successful reperfusion with TT (p=0.006 and p=0.042, respectively).

Conclusions: In the current study, we found that GI2 is an independent predictor for successful reperfusion in STEMI treated with TT. Fibrin specific regime should be preferred in anterior GI3.

Show MeSH
Related in: MedlinePlus