Myocardial damage after successful thrombolysis is associated with the duration of ST re‐elevation at reperfusion

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Abstract
The purpose of this study was to investigate the significance of ST re-elevation at reperfusion using strict criteria for patient inclusion and exclusion. Twenty-nine patients who had a first anterior infarction with single-vessel disease, successful recanalization by intracoronary thrombolysis (ICT) with urokinase, and an angiographically confirmed patent infarct-related artery after 4 weeks, were divided into three groups according to the deviation of the ST segment at reperfusion: Group A, 10 patients with sustained ST re-elevation; Group B, 10 patients with transient ST re-elevation; and Group C, 9 patients with ST reduction. Left ventricular (LV) function was evaluated from cineventriculograms performed in the 30° right anterior projection 4 weeks after ICT. LV ejection fraction and regional wall motion of the infarct area, evaluated by the centerline method (SD/chords), were significantly lower in Group A (44 ± 10%, -3.2 ± 0.4) than in Group B (61 ± 9%, -1.9 ± 0.7) and Group C (60 ± 5%, -2.0 ± 0.4) (p < 0.01). Peak creatine kinase (CK) activity was significantly higher in Group A (5848 ± 2112 IU) than in Group B (2485 ± 1254 IU) and Group C (1889 ± 1525 IU) (p < 0.05). These data suggest that a sustained ST re-elevation at reperfusion was strongly associated with marked LV dysfunction and higher peak CK activity. It was concluded that sustained, not transient, ST re-elevation associated with successful reperfusion indicates extensive myocardial damage.

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