Grade III Ischemia on Presentation with Acute Myocardial Infarction Predicts Rapid Progression of Necrosis and Less Myocardial Salvage with Thrombolysis
| Autor: | Kenneth W. Mahaffey, Raymond J. Gibbons, M. Atiar Rahman, Elena B. Sgarbossa, Kathy B. Gates, Robert M. Califf, Alejandro Barbagelata, Christopher B. Granger, Gabriel I. Barbash, Peter Clemmensen, Douglas A. Criger, Galen S. Wagner, Yochai Birnbaum |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Adult
Male Technetium Tc 99m Sestamibi medicine.medical_specialty Necrosis Adolescent medicine.medical_treatment Myocardial Infarction Myocardial Ischemia Ischemia Internal medicine medicine Humans Thrombolytic Therapy Pharmacology (medical) cardiovascular diseases Myocardial infarction Aged Retrospective Studies Tomography Emission-Computed Single-Photon medicine.diagnostic_test Vascular disease business.industry Myocardium Electrocardiography in myocardial infarction Thrombolysis Middle Aged Prognosis medicine.disease Disease Progression Cardiology Female Radiopharmaceuticals medicine.symptom Presentation (obstetrics) Cardiology and Cardiovascular Medicine business Electrocardiography |
| Zdroj: | Cardiology. 97:166-174 |
| ISSN: | 1421-9751 0008-6312 |
| Popis: | We assessed the relation between baseline electrocardiographic ischemia grades and initial myocardial area at risk (AR) and final infarct size (IS) in 49 patients who had undergone 99mTc sestamibi single-photon emission computed tomography before and 6 ± 1 days after thrombolysis. Patients were classed as having grade III ischemia (ST segment elevation with terminal QRS distortion, n = 19) or grade II ischemia (ST elevation but no terminal QRS distortion, n = 30). We compared AR and IS by baseline ischemia grade and treatment (adenosine vs. placebo) and assessed relations of infarction index (IS/AR ratio ×100) to time to thrombolysis, baseline ischemia grade, and adenosine therapy. Time to thrombolysis was similar for grade II and grade III. For placebo- treated patients, the median AR did not differ significantly between grade II (38%) and grade III patients (46%, p = 0.47), nor did median IS (16 vs. 40%, p = 0.096), but the median infarction index was 66 vs. 90% (p = 0.006). For adenosine-treated patients, median AR (21 vs. 26%, p = 0.44), median IS (5 vs. 17%, p = 0.15), and their ratio (31 vs. 67%, p = 0.23) did not differ significantly between grade II and grade III patients. The infarction index independently related to grade III ischemia (p = 0.0121) and adenosine therapy (p = 0.045). Infarct size related to baseline ischemia grade and was reduced by adenosine treatment. Necrosis progressed slowlier with baseline grade II versus III ischemia, which could offer more time for myocardial salvage with reperfusion. |
| Databáze: | OpenAIRE |
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