ASSESSMENT OF CORONARY-ARTERY PATENCY AFTER THROMBOLYTIC THERAPY - ACCURATE PREDICTION UTILIZING THE COMBINED ANALYSIS OF 3 NONINVASIVE MARKERS

The predictability of patency of the infarct-related artery assessed by means of three noninvasive easily obtainable markers was prospectively examined in 82 patients undergoing thrombolysis for their first myocardial infarction. Positive noninvasive markers were defined as follows: 1) early peak creatine kinase (CK) activity less-than-or-equal-to 12 h after the start of thrombolysis; 2) greater-than-or-equal-to 50% reduction in ST segment elevation; and 3) occurrence of reperfusion arrhythmias within the 1st 90 min of thrombolytic therapy. In 63 (77%) of the 82 patients, Thrombolysis in Myocardial Infarction (TIMI) grade II/III reperfusion was achieved within the 1st 90 min as assessed by coronary angiography. Separate analysis of each marker revealed the following respective values for sensitivity, specificity and positive and negative predictive value regarding prediction of coronary artery patency: CK peak less-than-or-equal-to 12 h: 84%, 95%, 98% and 64%; reduction of the ST segment elevation greater-than-or-equal-to 50%: 60%, 95%, 97% and 42%; and reperfusion arrhythmias: 63%, 89%, 95% and 43%. The combined analysis of all three markers utilizing a logistic regression procedure showed that CK peak (p = 0.0001) and resolution of the ST segment elevation (p = 0.005), but not the occurrence of reperfusion arrhythmias (p = 0.26), were independent predictors of vessel patency. From this logistic regression procedure, a sensitivity of 100%, a specificity of 90%, a positive predictive value of 97% and a negative predictie value of 100% for prediction of coronary artery patency were obtained. Thus, the combined analysis of three noninvasive markers permits accurate prediction of coronary artery patency in patients with acute myocardial infarction undergoing thrombolytic therapy.