Arq. Bras. Cardiol. 2019; 112(1): 30-31

Reperfusion Criteria in Patients Submitted to Fibrinolysis: Is There Room for Improvement?

Milena Soriano Marcolino , Antonio Luiz Pinho Ribeiro

DOI: 10.5935/abc.20180245

This Short Editorial is referred by the Research article "Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy".

Many ST-elevation acute myocardial infarction (STEMI) patients seek care in hospitals without percutaneous coronary intervention (PCI) capability and cannot be submitted to PCI within the guideline-recommended timelines, and, instead, they are often submitted to fibrinolysis as the initial reperfusion therapy. Rapid, simple and readily available bedside measures are of utmost importance for timely assessment of the efficacy of reperfusion therapy early after fibrinolysis in acute STEMI, in order to immediately identify the ones who require rescue PCI.^,

In an editorial for Circulation in 2001, Gibson stated “In a time of dizzying advances in diagnostic modalities, it is refreshing to see what a useful, simple, noninvasive, broadly accessible, easily repeatable/applied, and affordable tool the electrocardiography (ECG) is”. This is still up to date. Multiple studies have demonstrated improved outcomes among patients who achieve complete ST resolution at 60-90 minutes after fibrinolytic therapy, and it is recommended that the absence of > 50% reduction in ST elevation in the worst lead at 60-90 minutes should prompt strong consideration of coronary angiography and rescue PCI. ^, However, this measure, combined with the absence of reperfusion arrhythmias at 2 hours after treatment, has a positive predictive value of 87% and a negative predictive value of 83% to predict failure of reperfusion, ^, indicating that there is still room for improvement in accuracy.

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