ST elevation myocardial infarction assessing success of reperfusion
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| Myocardial infarction Classification and external resources | |
 | |
|---|---|
| Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). | |
| ICD-10 | I21.-I22. |
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
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Assessment of Reperfusion
Myocardial contrast echocardiography (MCE), angiographic myocardial perfusion grade (MPG), and assessment of ST segment resolution are recognized as useful techniques for assessing myocardial perfusion. [1]
The relatively simple and readily available evaluation of the ST segment resolution that exceeds 50% at 60 to 90 minutes after reperfusion is a good indicator of enhanced myocardial perfusion.
Persistence of ischemic chest pain, absence of ST segment resolution and hemodynamic and/or electrical instability are generally indicators of failed pharmacological reperfusion and the need to consider rescue PCI and application of aggressive medical treatment.
Clinical Trial Data
According to TIMI-14 study which was evaluated 888 patients; patients with TIMI 3 perfusion and >70% ST segment resolution had substantial enhancement of survival compared with patients without ST segment resolution, and angiographically patent infarct related arteries.[1]
Guidelines (Do Not Edit)
Class IIa
It is reasonable to monitor the pattern of ST elevation, cardiac rhythm, and clinical symptoms over the 60 to 180 minutes after initiation of fibrinolytic therapy. Noninvasive findings suggestive of reperfusion include relief of symptoms, maintenance or restoration of hemodynamic and or electrical stability, and a reduction of at least 50% of the initial ST-segment elevation injury pattern on a follow-up ECG 60 to 90 minutes after initiation of therapy. (Level of Evidence: B) [1]
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
