Figura 1 -Radiografia panorâmica de bacia em AP, mostrando diminuição do espaço articular à direita, além de achatamento da cabeça femoral ipsilateral.
BackgroundPatients with ST-elevation acute myocardial infarction attending primary care
centers, treated with pharmaco-invasive strategy, are submitted to coronary
angiography within 2-24 hours of fibrinolytic treatment. In this context,
the knowledge about biomarkers of reperfusion, such as 50% ST-segment
resolution is crucial.ObjectiveTo evaluate the performance of QT interval dispersion in addition to other
classical criteria, as an early marker of reperfusion after thrombolytic
therapy.MethodsObservational study including 104 patients treated with tenecteplase (TNK),
referred for a tertiary hospital. Electrocardiographic analysis consisted of
measurements of the QT interval and QT dispersion in the 12 leads or in the
ST-segment elevation area prior to and 60 minutes after TNK administration.
All patients underwent angiography, with determination of TIMI flow and
Blush grade in the culprit artery. P-values < 0.05 were considered
statistically significant.ResultsWe found an increase in regional dispersion of the QT interval, corrected for
heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in
anterior wall infarction in patients with TIMI flow 3 and Blush grade 3
[T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria
for reperfusion (i.e., > 50% ST-segment resolution), the area under the
curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with
coronary flow of T3B3(+). In patients with ST-segment resolution >50% and
regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for
reperfusion in T3B3(+), and 6% of patients with successful reperfusion were
reclassified.ConclusionOur data suggest that regional QTcD is a promising non-invasive instrument
for detection of reperfusion in the culprit artery 60 minutes after
thrombolysis.
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