الفهرس 
ELECTROCARDIOGRAM IN THE DIAGNOSIS OFOnly 14 pages are availabe for public view
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Abstract
A
nalysis of ST-segment resolution on ECG, after fibrinolytic therapy, in cases of ST elevation Myocardial Infarction offers an attractive and cost effective solution to assess coronary reperfusion. whereas coronary angiogram is a marker for epicardial reperfusion, ST segment resolution offers a better reflection of microvascular reperfusion. Although successful thrombolysis of the epicardial vessel is necessary for good prognosis, but the micro-vascular flow more strongly correlates with the outcome. ST segment is therefore a better indicator of prognosis, and provides information,
The aim of the work to evaluate the ST segment resolution after reperfusion by thrombolytic therapy as a prognostic predictor of clinical outcome in patients with ST segment elevation myocardial infarction.
Forty patients were included in the study. Their age ranged between 42 to 67 years with a mean of 56.2 ± 7.9 years. They were 29 males (86.3%) and 11 females (13.7%).
Patients received thrombolytic therapy for ST-elevation myocardial infarction were included in the study. Patients with contraindications to thrombolysis, prior history of myocardial infarction, late presentation > 12 hours and non ST elevation MI were excluded from the study.
All patients included in the study were subjected to: Full history taking, general clinical examination, local cardiac examination, resting twelve-leads surface ECG to localize the site of myocardial ischemia or infarction, full echo-Doppler study and coronary angiography.
The ST-segment elevation resolution was calculated as the initial sum of ST-segment elevation minus the sum of ST-segment elevation on the second ECG divided by the initial sum of ST-segment elevation and expressed as a percentage. Two cutoff points of ST-segment resolution (70% and 30%) were applied, which defined 3 groups of ST-segment resolution: complete ( 70%), partial or intermediate (<70% to 30%), and no resolution (<30%).
The study showed that the mean ST segment elevation decreased significantly 60 minute after thrombolytic therapy and at discharge. The changes in ST segment were highly significant. 21 patients (53.8%) had complete ST segment resolution, 10 patients (25.6%) had intermediate ST segment resolution and 9 patients (23%) had no ST segment resolution.
In-hospital major adverse events were defined as the occurrence of any of the following: death, reinfarction, stroke, cardiogenic shock, emergency revascularization (either PCI or CABG), recurrent angina or ischemia (post-infarction angina), significant arrhythmias or major bleeds. An uncomplicated course was defined as no major adverse event during the entire inpatient stay.
The study showed that 2 patients died 24 hours after admission, post infarction angina occurred in 3 patients (7.5%), Emergency PCI was done to 2 patients (5%), and emergency CABG in 1 patient (2.5%) (this patient had left main 90% lesion) and heart failure occurred in 4 patients (10%).
MACE were significantly higher among patients with no STR than those with intermediate STR and with complete STR.
There was no significant difference between patients with complete ST segment resolution, those with intermediate ST segment resolution and those with no ST segment resolution regarding their mean age, the sex distribution and risk factors for coronary artery disease.
The end diastolic diameter, end systolic diameter were significantly larger among patients with no ST segment resolution than those with intermediate and those with complete ST segment resolution. The Ejection fraction (%) and Fraction shortening (%) were significantly lower among patients with no ST segment resolution than those with intermediate and those with complete ST segment resolution. The incidence of mitral regurgitation was significantly higher among patients with no STR versus patients with complete STR and intermediate STR. The wall motion score index was significantly higher among patients with no STR versus patients with complete STR and intermediate STR.
The study showed that the severity of coronary artery disease was significantly higher among patients with no STR versus patients with intermediate STR and those with complete STR as evidenced from the higher incidence of totally occluded coronary artery disease and the lower TIMI flow among patients with no STR.