[Prognostic value of noninvasive makers of coronary reperfusion in patients with acute myocardial infarction treated with thrombolysis]. / Valor pronóstico de los índices no invasivos de reperfusión coronaria en pacientes con infarto agudo del miocardio tratados con trombolisis.

BACKGROUND: The immediate prognosis of patients with acute myocardial infarction treated with thrombolysis primarily depends on obtaining a satisfactory coronary reperfusion. AIM: To assess the prognostic power of four markers of coronary artery patency in patients with acute myocardial infarction treated with Streptokinase 1.5 million U within the first six hours of symptoms. PATIENTS AND METHODS: In 807 consecutive patients from the Chilean National Registry of Acute Myocardial Infarction we analyzed the resolution of chest pain and ST segment elevation over 50% within the first 90 min, abrupt CK rise within 8 h and T wave inversion in infarct related EKG leads within the first 24 h after thrombolysis. RESULTS: Global in-hospital mortality was 12.1%. Mortality of patients with the presence of 3 or 4 markers of coronary artery patency was 5.1%, in those with resolution of ST elevation and abrupt CK rise was 6.25% and in those with T wave inversion it was 3.9% (p < 0.001). Multivariate analysis, adjusted by age, gender, risk factors, Killip class and infarct location showed that early T wave inversion was the better predictor of a low in-hospital mortality and that its combination with other markers of coronary artery patency did not increase its prognostic power. Early CK rise and the presence of 3 out of 4 reperfusion criteria were also independent predictors of a low mortality. CONCLUSIONS: Non invasive markers of coronary artery patency are associated with a lower in-hospital mortality and may serve as surrogate end points in clinical trials.