Early noninvasive identification of failed reperfusion after intravenous thrombolytic therapy in acute myocardial infarction

Department of Cardiology, Green Lane Hospital, Auckland, New Zealand. Jims@ahsl.co.nz

OBJECTIVES: This study sought to evaluate a biochemical approach to the early noninvasive assessment of reperfusion. BACKGROUND: In patients with an acute myocardial infarction, a rapid noninvasive method of detecting failure of intravenous thrombolytic therapy to restore early Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in the infarct-related artery (IRA) is needed. METHODS: Serial blood samples were collected to assay creatine kinase-MB fraction (CKMB mass), cardiac troponin T and myoglobin concentrations in 105 patients with a myocardial infarction who underwent early angiography after intravenous streptokinase. The ratios of the 60- and 90-min concentrations to prethrombolytic values were used to determine an index that could identify failure to achieve TIMI grade 3 flow in the IRA at 90 min. RESULTS: Significant increases in serum concentrations of markers at 60 min were more likely with TIMI grade 3 flow (59 patients) than with TIMI grade 0 to 2 flow (46 patients). Ratios < or = 5 at 60 min after thrombolysis detected failure to achieve 90-min TIMI grade 3 flow with 92% to 97% sensitivity, 43% to 60% specificity and 63% to 76% positive and 86% to 94% negative predictive values. Ratios < or = 10 at 90 min showed 88% to 95% sensitivity, 49% to 65% specificity and 61% to 69% positive and 86% to 94% negative predictive values for TIMI flow grade < 3. The overall predictive values were thus similar for all three markers. CONCLUSIONS: In acute myocardial infarction treated with intravenous streptokinase, a simple measurement of increased serum concentrations of CKMB mass, cardiac troponin T or myoglobin at 60 and 90 min can accurately predict failure to achieve TIMI grade 3 flow in the IRA at 90 min.

This article has been cited by other articles:

				F. Marin, R. Gonzalez-Conejero, P. Capranzano, T. A. Bass, V. Roldan, and D. J. Angiolillo Pharmacogenetics in Cardiovascular Antithrombotic Therapy J. Am. Coll. Cardiol., September 15, 2009; 54(12): 1041 - 1057. [Abstract] [Full Text] [PDF]

				J J Edmond, C P Juergens, and J K French The pharmaco-invasive approach to STEMI: when should fibrinolytic-treated patients go to the "cath lab"? Postgrad. Med. J., June 1, 2009; 85(1004): 331 - 334. [Abstract] [Full Text] [PDF]

				J J Edmond, C P Juergens, and J K French The pharmaco-invasive approach to STEMI: when should fibrinolytic-treated patients go to the "cath lab"? Heart, March 1, 2009; 95(5): 358 - 361. [Abstract] [Full Text] [PDF]

				S G Foussas, M N Zairis, S S Makrygiannis, S J Manousakis, F A Anastassiadis, C S Apostolatos, N G Patsourakos, M P Glyptis, J K Papadopoulos, D C Xenos, et al. The significance of circulating levels of both cardiac troponin I and high-sensitivity C reactive protein for the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction Heart, August 1, 2007; 93(8): 952 - 956. [Abstract] [Full Text] [PDF]

				NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, and R. H. Christenson National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes Circulation, April 3, 2007; 115(13): e356 - e375. [Full Text] [PDF]

				NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, R. H. Christenson, NACB COMMITTEE MEMBERS, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes Clin. Chem., April 1, 2007; 53(4): 552 - 574. [Full Text] [PDF]

				Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]

				F. Marin, R. Gonzalez-Conejero, K. W. Lee, J. Corral, V. Roldan, F. Lopez, F. Sogorb, J. Caturla, G. Y.H. Lip, and V. Vicente A pharmacogenetic effect of factor XIII valine 34 leucine polymorphism on fibrinolytic therapy for acute myocardial infarction J. Am. Coll. Cardiol., January 4, 2005; 45(1): 25 - 29. [Abstract] [Full Text] [PDF]

				E. Iraculis, A. Cequier, J. A. Gomez-Hospital, M. Sabate, J. Mauri, E. Fernandez-Nofrerias, B. Garcia del Blanco, F. Jara, and E. Esplugas Early dysfunction and long-term improvement in endothelium-dependent vasodilation in the infarct-related artery after thrombolysis J. Am. Coll. Cardiol., July 17, 2002; 40(2): 257 - 265. [Abstract] [Full Text] [PDF]

				J. A. de Lemos and E. Braunwald ST segment resolution as a tool for assessing the efficacy of reperfusion therapy J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1283 - 1294. [Abstract] [Full Text] [PDF]

				E. Giannitsis, M. Muller-Bardorff, S. Lehrke, U. Wiegand, R. Tolg, B. Weidtmann, F. Hartmann, G. Richardt, and H. A. Katus Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction Circulation, August 7, 2001; 104(6): 630 - 635. [Abstract] [Full Text] [PDF]

				J.D. Kovac and A.H. Gershlick How should we detect and manage failed thrombolysis? Eur. Heart J., March 2, 2001; 22(6): 450 - 457. [PDF]

				M. T. Roe, E. M. Ohman, A. C. P. Maas, R. H. Christenson, K. W. Mahaffey, C. B. Granger, R. A. Harrington, R. M. Califf, and M. W. Krucoff Shifting the open-artery hypothesis downstream: the quest for optimal reperfusion J. Am. Coll. Cardiol., January 1, 2001; 37(1): 9 - 18. [Abstract] [Full Text] [PDF]

				M. A de Belder CORONARY DISEASE: Acute myocardial infarction: failed thrombolysis Heart, January 1, 2001; 85(1): 104 - 112. [Full Text]

				S. Matetzky, T. Sharir, M. Domingo, M. Noc, K.-Y. Chyu, S. Kaul, N. Eigler, P. K. Shah, and B. Cercek Elevated Troponin I Level on Admission Is Associated With Adverse Outcome of Primary Angioplasty in Acute Myocardial Infarction Circulation, October 3, 2000; 102(14): 1611 - 1616. [Abstract] [Full Text] [PDF]

				L. E. Goldman and M. J. Eisenberg Identification and Management of Patients with Failed Thrombolysis after Acute Myocardial Infarction Ann Intern Med, April 4, 2000; 132(7): 556 - 565. [Abstract] [Full Text] [PDF]