Clinical and laboratory signs of reperfusion: are they reliable?

We studied 101 patients (88 men and 13 women, mean age 54.5 ± 10 years) who arrived at the hospital during the first 6 hours of acute myocardial infarction evolution. Our objective was to assess the reliability of clinical and laboratory signs of recanalization using intravenous streptokinase as a t...

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Veröffentlicht in:International journal of cardiology 1989-12, Vol.25 (3), p.313-320
Hauptverfasser: Nicolau, JoséCarlos, Lorga, Adalberto Menezes, Garzon, Sérgio Aloísio Coimbra, Jacob, JoséLuiz Balthazar, Machado, Nilton Carlos Spínola, Bellini, Álvaro José, Greco, Oswaldo Tadeu, Marques, Luiz Alcides Fusco, Braile, Domingo Marcolino
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Sprache:eng
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Zusammenfassung:We studied 101 patients (88 men and 13 women, mean age 54.5 ± 10 years) who arrived at the hospital during the first 6 hours of acute myocardial infarction evolution. Our objective was to assess the reliability of clinical and laboratory signs of recanalization using intravenous streptokinase as a thrombolytic agent. The mean time between the beginning of infusion and coronary arteriography was 53.83 ± 43 hours. The positive predictive values for pain, arrhythmia, ST segment and enzymes were 97.9%, 94.2%, 91.8% and 90.8%, respectively; the negative predictive values were 46.8%, 40.8%, 37.2% and 50% in the same order. Sensitivity was 65.7%, 62.8%, 58.4% and 77.6% and specificity 95.6%, 86.9%, 82.6% and 73.9%, respectively. The positive predictive value, calculated on the basis of the presence of each variable alone or in association showed a probability of recanalization of 76.9% for one sign, 84% for two, 96.3% for three and 100% for all four. When we compared the positive predictive values of each variable according to the interval between the beginning of pain and admission to the hospital (during the first 3 hours or between 3 and 6 hours) our results were 100% 94% for pain ( P = NS), 97% 88% for arrhythmia ( P = NS), 100% 75% for ST segment ( P = 0.004), and 97% 80% for enzymes ( P = 0.019). The same analysis applied to negative predictive values showing 22% 62% ( P = 0.007), 17% 55% ( P = 0.008), 21% 47% ( P = NS), 27% 61% ( P = NS) for pain, arrhythmia, ST segment and enzymes, respectively. From these data we concluded that these signs are not ideal but sufficiently reliable as indicators of recanalization post-intravenous streptokinase, especially when 3 or 4 of them are present, or when they appear in patients within 3 hours post-infarction.
ISSN:0167-5273
1874-1754
DOI:10.1016/0167-5273(89)90221-0