Endomyocardial fibrosis associated with antiphospholipid syndrome

Abstract

Objective-To determine whether simple, readily applicable ECG criteria will allow early prediction of inadequate (< TIMI 3) flow in the infarct related vessel in patients receiving thrombolytic treatment for acute myocardial infarction; and to determine the success of streptokinase in achieving adequate antegrade flow in the infarct related vessel two hours after starting treatment.Design-Cohort study.Setting-Regional cardiothoracic unit.Patients-100 sequential patients with acute myocardial infarction.Interventions-Coronary angiography two hours after the initiation of thrombolytic treatment, proceeding to rescue angioplasty for inadequate flow in the infarct related vessel where appropriate.Main outcome measures-Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of six ECG criteria for the detection of inadequate antegrade flow in the infarct related vessel.Results-The ECG test that performed best as a positive test for < TIMI 3 flow in the infarct related vessel was < 50% resolution of the ST segment elevation in the worst lead and no accelerated idioventricular rhythm.This had a sensitivity of 81%, specificity of 88%, positive predictive value of 87%, negative predictive value of 83%, and overall accuracy of 85%.Conclusions-Sensitive, specific, and simple ECG criteria are defined for diagnosing failure of thrombolytic treatment with streptokinase.These allow the early detection of patients at high risk of further adverse events from a persistently occluded vessel.They may be used without recourse to sophisticated equipment or complex analyses.Such patients can then be considered for alternative treatments or enrolment into appropriate research protocols.