Vol - 25, Issue - 1
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[This article belongs to Volume - 25, Issue - 1]
International Medical Journal
Journal ID : IMJ-01-01-2020-114
Total View : 495

Abstract : Acute myocardial infarction (AMI) is a critical condition that requires urgent intervention. The goals of treatment are usually to restore the patency of the affected coronary artery, and myocardial reperfusion within a relatively short time period. Many thrombolytic drugs can meet these criteria. However, successful thrombolysis cannot be easily confirmed or predicted. To evaluate the predictive values of QT interval and QRS duration dispersions for successful thrombolysis in patients with acute ST-elevation myocardial infarction. This is an observational prospective study which included a total of 90 adult patients with acute ST-elevation myocardial infarction (STEMI) that underwent therapeutic thrombolysis. Electrocardiographic (ECG) traces were carried out at patient’s admission, immediately before and 90 minutes post infusion of thrombolytic drug. Traces were analyzed by a single observer, with no previous knowledge on the status of the patient. Sixty-six patients were treated with alteplase, while tenectaplase was used to treat the other 24 patients. Response to thrombolytic drug was defined as ≥50% decrease of maximum ST elevation 90 minutes after the initiation of thrombolytic drug. From each ECG trace, the corrected QT dispersion (QTcd) and QRS dispersion (QRSd) were calculated. Receiver operating characteristic (ROC) curves were used to assess the QRSd and QTcd as predictors for successful thrombolysis as indicated by regression of maximum ST elevation. Values of both QRSd and QTcd were comparable between alteplase and tenectaplase-treated patients before and after treatment with no significant differences. In both groups, there were significant reductions in both QTcd and QRSd 90 minutes after thrombolytic treatment. In alteplase-treated patients, the sensitivity and specificity of QRSd for prediction of successful thrombolysis at cut off value of 22 ms were 68% and 67% respectively, and for QTcd at cut off value of 72 ms were 79% and 87% respectively. In, tenectaplase-treated patients, the sensitivity and specificity of QRSd at cut off value of 12 ms were 84% and 82% respectively, and for QTcd at cut off value of 49 ms were 80% and 74% respectively. Thrombolytic therapy causes a marked reduction in QRS and QTc dispersion. QRS and QTc dispersion have good sensitivity and specificity in predicting successful thrombolysis, which was more prominent in tenectaplase than in alteplase-treated patients with STMI. Using the combination of QRSd and QTcd can increase the predictive values of ECG parameters for successful thrombolysis

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