Poor Microvascular Reperfusion ("No Reflow"): Best Diagnosed by ECG

This study demonstrates the importance of frequent static ECG’s and the insensitivity of using only 2 static ECG’s to detect reperfusion.  In 58% of patients, ST segments were unstable, rising and falling, before final resolution.Infrequent static ECG’sCaliff RM et al., Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis, 1988.  Methods:  Califf et al. (339) performed angiography on 386 TAMI patients at 60 and 90 minutes post-administration of tissue plasminogen activator (tPA).  They recorded a baseline ECG and another at 90 minutes post-tPA, before the 90-minute coronary injection.  Findings:  They found no sensitive AND specific marker of reperfusion using infrequent static ECG’s.  Complete resolution of ST segment and T-wave changes was associated with a 96% IRA patency rate at 90 minutes post-tPA, but this occurred in only 6% of patients.  Only 38% of patients had “partial resolution” of ST segments, 84% of whom showed reperfusion.  Complete resolution of CP occurred in 29%, of whom 84% had reperfusion of the IRA.  Unchanged or worsened CP occurred in 20%, of whom 60% showed reperfusion.  Patent IRA’s were demonstrated in 56% of patients with neither symptom nor ST resolution and 63% of patients with no change in ST segments showed reperfusion.  Although arrhythmias occurred frequently during the first 90 minutes of therapy, none were associated with a...

Source: Dr. Smith's ECG Blog - August 9, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs