Clinical Markers of Reperfusion in Patients with Acute Myocardial Infarction and Its Prognostic Significance

• Main Authors: Anuj R Varma Assistant Professor, Swapnil Chillawar Assistant Professor, T K Kamble Professor, Sourya Acharya Professor
• Format: Article
• Language: English
• Published: Thieme Medical and Scientific Publishers Pvt. Ltd. 2016-12-01
• Series: International Journal of Recent Surgical and Medical Sciences
• Subjects: coronary artery disease; reperfusion; streptokinase; thrombolysis
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.5005/jp-journals-10053-0020
• ISSN: 2455-7420; 2455-0949

Introduction: Coronary artery disease (CAD) is a major cause of mortality worldwide. Thrombolysis in the treatment of acute myocardial infarction (AMI) is a landmark event in the management as it has changed the outcomes. Clinical signs after thrombolysis in AMI may have a better correlation with functional reperfusion than the isolated image of angiographic patency. Aims and objectives: To study successful clinical reperfusion (SCR) noninvasively using clinical markers of reperfusion. To evaluate the prognostic value of clinical markers of reperfusion in predicting early (30 days) prognosis after thrombolysis in AMI. To observe the effect of age, location of MI, presence of previous infarction, Killip's class at admission, and presence of clinical reperfusion assessed noninvasively on early (30 days) prognosis after AMI. Materials and methods: All the patients were thrombolyzed (using streptokinase). Successful clinical reperfusion was defined by the presence of at least two of the following criteria at 2 hours of starting treatment: (1) Significant relief of pain (50% or more), (2) 50% or more reduction in sum of ST segment elevation, (3) abrupt initial rise of creatine kinase MB (CK-MB) level, more than two-fold over upper normal or baseline values. Results: Duration of symptoms (min) mean ± SD was nearly the same in two groups (94.80 ± 13.68 vs 96.19 ± 17) but early thrombolysis resulted in better outcome (0.01 S, p < 0.05). killips class at admission (KAD) > OR = 2, n (%) led to worsened fate of thrombolysis. Death n (%) occurred in 7 (8.75%) patients with 1 (1.25%) from SCR (+) group and 6 (7.5%) from SCR (–) group (0.01 S, p < 0.05). Conclusion: It is concluded that Killip's class at admission of more than or equal to two and absence of SCR are the predictors of mortality after thrombolysis. Absence of SCR defines a group of patients with poorer prognosis after thrombolysis and in such patients alternative strategies of reperfusion should be considered.