Coronary Recanalization VS. Myocardial Reperfusion in Acute Myocardial Infarction. Prognostic Value of Clinical Markers of Reperfusion in Patients with TIMI 3 flow after Thrombolytic Therapy

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Abstract

Objectives

The aim of this study was to evaluate the prognostic value of clinical markers of successful reperfusion in patients with acute myocardial infarction(AMI) and TIMI 3 flow after thrombolytic therapy.

Material and methods We studied 79 consecutive patients with AMI who received thrombolytic treatment within the first 6hours of symptom onset and showed TIMI 3 flow in the infarct related artery. Successful clinical reperfusion (SCR) was defined by the presence ofat least two of the following criteria two hours after treatment: 1) reduction >_ 50% in the sum of ST segment elevation, 2) significant relief of pain, 3)abrupt initial increase of baseline CK levels.   Results SCR was positive in 66 patients (Group I) and negative in 13 (Group II). There were significant differences between Group I and Group II in heart failure (0% vs. 15.4%, p = 0.025), and a strong trend in mortality (4.5% vs. 23.1%, p = 0.052) and combined events (19.7% vs. 46.1%, p = 0.07) during the follow-up (23 ± 13 months). In the multivariate analysis only age > 65 years (p = 0.015), gender (females, p = 0.0001) and absence of SCR (p = 0.03) were independent predictors of mortality in the follow-up, whereas gender (female, p = 0.036), and absence of SCR (p = 0.003), were independent predictors of combined events.   Conclusions In patients with AMI and TIMI 3 flow after thrombolytic therapy, the presence of SCR was an independent determinant of better long-term prognosis.