Home | Aim of this blog | Archives
May 27, 2009 4:40 pm
Thrombolytic therapy , has been the specific treatment for STEMI for many decades. Primary PCI* is shown to be superior than thrombolysis if performed early by an experienced team in a dedicated facility. (*Conditions apply). It is estimated , currently only a a fraction STEMI population get primary PCI (<5%) in ideal conditions . Another fraction , get primary PCI by inexperienced cardiologists in low volume centres.
So , thrombolysis remains, and would continue to remain , the primary mode of therapy for STEMI in the present and near future !
How do you assess the successful thrombolysis ?
It should be recognised , there is a fundametal flaw in this question !
The aim of thrombolytic therapy is not to lyse the thrombus , but also to restore the coronary blood flow to the myocardium – also called reperfusion . One may wonder , why the term , thrombolysis should ‘t be used interchangeably with reperfusion.
A successful thrombolysis never guarantees a good reperfusion , for the simple reason , distal blood flow in an obstructed coronary artery is dependent on , many factors other than relief of obstruction.
Apart from the potency of drug, other important factors that determine successful lysis & reperfusion are . . .
So , we should primarily assess myocardial reperfusion rather than epicardial thrombolyis ! following thrombolysis .
What are the parameters available to assess successful reperfusion /thrombolyis?
ECG ST regression , is a direct indicator myocardial reperfusion as the ST segment shifts towards baseline , implies of infarct current of injury . ST regression almost always correlate with good recovery of LV function in STEMI .
IRA patency , is an epicardial index , it does not give information about myocardial blood flow . But , a good distal TIMI flow generally indicates good reperfusion.This again , is not a fool proof index, as even many of the TIMI 3 flow patients have severely damaged myocardium by echocardiography .
Final message
For the above reasons, one should always make a distinction between successful lysis and successful reperfusion . Surprisingly , ECG is the gold standard for assessing successful reperfusion of myocardium , while CAG tell us about epicardial patency and possibly reperfusion also.
Posted by dr s venkatesan
Categories: Cardiology - Clinical, cardiology -ECG, Cardiology -Interventional -PCI, cardiology -Therapeutics, Cardiology -unresolved questions
Tags: aivr, myocardial reperfusion, no reflow, nstemi, primary pci, reperfusion, reteplase, stemi, streptokinsae, successful reperfusion, successful thrombolysis, tenekteplase, thrombolysis, tpa, what is successful thrombolysis
Mobile Site | Full Site
Get a free blog at WordPress.com Theme: WordPress Mobile Edition by Alex King.