Early Recurrence Of St-Segment Elevation In Patients With Initial Reperfusion During Thrombolytic Therapy - Impact On In-Hospital Reinfarction And Long-Term Vessel Patency

Aim: To investigate the frequency and prognostic impact of early recurrent ST-segment elevation after initial ST-segment resolution in patients with acute myocardial infarction who had been treated with intravenous thrombolysis.Methods: Eighty-one patients with acute myocardial infarction underwent 24 h Hotter monitoring of the infarct-related ST-segment elevation, at the initiation of thrombolytic therapy. Angiography was performed in 88% of the patients 9+/-4 days after infarction.Results: Resolution of the ST-segment elevation during the first 4 h, suggestive of early reperfusion, occurred in 67 (83%) patients (group 1). Of these, 31 (46%) had subsequent re-elevations (group la), 26 during the first 4h, and 20 later. Thirty-six (54%) patients had no recurrence of the ST-segment elevation (group Ib). During follow-up, patients in group la experienced more in-hospital reinfarctions (26 versus 6%, P=0.04) and had a higher rate of occluded infarct-related vessels at angiography than patients in group Ib (40 versus 17%, P=0.01).Conclusion: During the first 24 h after initiation of thrombolytic therapy, recurrences of ST-segment elevation are frequent in myocardial infarction patients with ECG signs of an initially reperfused infarct-related artery. Recurrence of ST-segment elevation indicates a higher risk of reinfarction during hospitalization and of long-term occlusion of the infarct artery.