A comparison of in-Hospital complications with ST segment elevation resolution after thrombolytic therapy in acute myocardial infarction


  • Aziz Muzafar Jaafer Department of Internal Medicine, Hawler teaching hospital, Erbil, Iraq.
  • Abdulkareem Abdulwahhab Al-Othman Department of Internal Medicine, college of medicine, Hawler medical university, Erbil, Iraq.




ST-segment elevation resolution, thrombolytic therapy


Background and objective: The primary goal of thrombolytic therapy in ST-segment elevation myocardial infarction is to restore the complete coronary reperfusion. The aim of the study was to assess the association of in- Hospital complications with ST-segment resolution after thrombolytic therapy in acute myocardial infarction.

Methods:  The ECG s of 100 patients with first ST-segment elevation myocardial infarction were recorded on admission, 90 and 180 minutes after Alteplase at Hawler Teaching Hospital (Coronary Care Unit) from January 2011 to October 2011. The mean age (±SD)was 59.8±8.4years,ranging from 37-80 years, 63% were males and 37% were females, male to female ratio equal 1.7:1. Patients were divided into three groups: Group (A): complete resolution of ST segment, group (B) : partial resolution and group (C) no resolution of ST-segment, those patients were followed for the detection of in-Hospital complications.

Results: Heart failure cardiogenic shock,left ventricular systolic dysfunction and ischemic mitral regurgitation were higher in group (B) and (C) than (A) when ECGs were recorded at 90 and 180 minutes after thrombolysis (P < 0.001).

Conclusion: Failure or partial resolution of ST segment can predict the early development of heart failure, shock, left ventricular systolic dysfunction and ischemic mitral regurgitation.


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Schröder R. Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction. Circulation 2004;110: 506-10.

De Lemos JA, Braunwald E. ST segment resolution as a tool for assessing the efficacy of reperfusion therapy. J Am Coll Cardiol 2001; 38: 1283-94

Roe MT, Ohman EM, Maas ACP, et al. shifting the open artery hypothesis is downstream: the quest for optimal reperfusion. AmJ Coll Cardiol 2001; 37:9–18.

Carlsson J, Kamp U, Härtel D, Brockmeier J, Meierhenrich R, Miketic S, et al. Resolution of ST-segment elevation in acute myocardial infarction-early prognostic significance after thrombolytic therapy. Results from the COBALT trial. 1999; 24: 440-7.

Somitsu Y, Nakamura M, Degawa T, et al. Prognostic value of slow resolution of ST-segment elevation following successful direct percutaneous transluminal coronary angioplasty for recovery of left ventricular function. Am J Cardiol 1997;80:406–10.

Santoro G, Antoniucci D, Valenti R, et al. Rapid resolution of ST-segment elevation after successful direct angioplasty in acute myocardial infarction. Am J Cardiol 1997;80:685–9.

Thygesen K,Alpert JS,WhiteHD,et al.Universal definition of myocardial infarction.Circulation 116:2634,2007.

Hanlon P, Byers M ,Walker BR , Macdonald HM. Environmental and natural factors in diseases .In: Colledge NR, Walker BR,Stuart HR(edit..Davidsons Principle and Practice of Medicine.21st edition .Churchill Livingstone.2010; p 116.

Purcell IF.Newell N, farrer M. Change in ST segment elevation 60minutes after thrombolytic initation predicts clinical outcome as accurately as later electrocardiographic changes .Heart 1997;78:465-71.

Schroder R,DIssman R,Bruggmann T, Wegschieder K,Linderer T, Tebbe U,et al. extent of early ST segment elevation resolution : A simple but strange predictor of outcome in patients with acute myocardial infarction .Jam Coll Cardiol.1994;24:384-91.

McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. New England Journal of Medicine. 1971 Dec; 23;285(26):1441-6.

Judith S ,Hochman, David H and Ingbar ,cardiogenic shock and pulmonary edema in: Fauci, Braunwald, Ksper, Hauser, Longo, Jameson and Localzoet (edit). Harrison's Principle of Internal Medicine , 17th edition, Mc Graw hill, 2008, chapter 226.p.1702-1703.

Ramadas G, Pal and Pravin M. Shah. Assessment of left ventricular Function.In: Grald M, Pohost A.O, Daniels B, Pravin M.,(eds)Imaging in Cardiovascular Diseases. First ed.Lippincott Williams and Willkins .2000.p. 23-41.

Enriquez- Saramo M, Schaff HV, Tajik AJ. Chronic mitral Regurgitation. In: Alpert JS, Dalen JE, Rahimtoala SH (eds): Valvular Heart Disease. 3rd ed. Philadelphia. Lippincott Williams and Wilkins.2000. p. 113-142.

Matsummura T, Ohtaki E, Tanaka K. Echocardiographic predictors of Left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair. Am J Cardiol.2003; 42:458.

Feigenbaum H,Armstrong WF, Ryan T. Coronary Artery Disease.Feigenbaum's Echocardiography, mmm 6th Edition, Lippincott Williams and Wilkins Company,2005.p.306-469.

M Sezer, Y Nisanci, B Umman, et al .New support for clarifying the relation between ST segment resolution and micro vascular function: degree of ST segment resolution correlates with the pressure derived collateral flow index. Heart 2004 90: 146-250.

Granger CB, Goldberg RJ, Dabbous OH et al. for the Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003;163:2345–2353

Tomaszuk-Kazberuk A, Musial WJ, Dobrzycki S, Korecki J. Normalisation of elevated ST segment predicts return of left ventricular systolic function and improved outcome in patients with acute myocardial infarction, treated with primary coronary angioplasty. Cardiol Pol 2004; 60: 541-9

Schro¨der R, Wegscheider K, Schroder K, Dissmann R, Meyer- Sabellek W, for the INJECT Trial Group. Extent of early ST segment elevation resolution: a strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. A substudy of the International Joint Efficacy Comparison of Thrombolytics (INJECT) trial. J Am Coll Cardiol 1995;26:1657–64.

Lee SG, Cheong JP, Shin JK, Kim JW, Park JH. Persistent ST-segment elevation after primary stenting for acute myocardial infarction: its relation to left ventricular recovery. Clinical Cardiology 2002; 25: 372-7.

Otsuji Y, Handschumacher MD, Liel-Cohen N, Tanabe H, Jiang Schwammenthal E et al. Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation.AmJ Coll Cardiol 2001;37:641–8.




How to Cite

Jaafer, A. M., & Al-Othman, A. A. (2013). A comparison of in-Hospital complications with ST segment elevation resolution after thrombolytic therapy in acute myocardial infarction. Zanco Journal of Medical Sciences (Zanco J Med Sci), 17(3), 495–501. https://doi.org/10.15218/zjms.2013.0039



Original Articles