ST Resolution 1 Hour After Fibrinolysis for Prediction of Myocardial Infarct Size: Insights from ASSENT 3

Journal Article

Acute ST-segment elevation myocardial infarction requires prompt restoration of myocardial perfusion to salvage myocardium at risk of ischemic necrosis and improve clinical outcome. Early resolution of ST-segment elevation during the time after reperfusion has been associated with both these end points. From the ASsessment of the Safety and Efficacy of a New Thrombolytic regimen (ASSENT) 3 trial, 3,425 patients were analyzed to investigate whether the amount of ST-segment resolution, divided into 3 groups (complete, >70%; partial, 30% to 70%; and no resolution, <30%), in the first hour after initiation of therapy was a predictor of final infarct size, estimated by peak creatine kinase and Selvester QRS score on the discharge electrocardiogram. Complete compared with partial and no ST resolution resulted in significantly (p <0.001) smaller infarct sizes of 10.5%, 13.2%, and 15.0% of the left ventricle and significantly (p = 0.001) fewer patients with peak creatine >5 times the upper reference level at 50.3%, 71.8%, and 76.3%, respectively. In conclusion, our findings supported previous smaller studies suggesting that early resolution of ST elevation, as a sign of early myocardial reperfusion, resulted in less myocardial damage and preservation of left ventricular function. © 2009 Elsevier Inc. All rights reserved.

Full Text

Duke Authors

Cited Authors

  • Johanson, P; Fu, Y; Wagner, GS; Goodman, SG; Granger, CB; Wallentin, L; Werf, FVD; Armstrong, PW

Published Date

  • 2009

Published In

Volume / Issue

  • 103 / 2

Start / End Page

  • 154 - 158

PubMed ID

  • 19121428

International Standard Serial Number (ISSN)

  • 0002-9149

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2008.08.054