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Diagnosis of coronary artery rethrombosis after effective systemic thrombolytic therapy in patients with ST-segment elevation myocardial infarction
  1. Valentin E Oleynikov1,
  2. Simon Matskeplishvili2,
  3. Ekaterina Shigotarova1,
  4. Alexey Kulyutsin1,
  5. Nadezhda Burko1
  1. 1 Therapy Department, Penza State University, Penza, Russian Federation
  2. 2 Cardiology Department, Lomonosov Moscow State University Clinic, Moscow, Russian Federation
  1. Correspondence to Dr Valentin E Oleynikov, Therapy Department, Penza State University, Penza 440026, Russian Federation; v.oleynikof{at}gmail.com

Abstract

The aim of the study was to evaluate the diagnostic significance of ST-segment re-elevation episodes registered with telemetric ECG monitoring in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombolytic therapy (TLT). The study included 117 patients with STEMI following effective TLT. The elective coronary angiography followed by percutaneous coronary interventions was performed in the interval from 3 to 24 hours after a successful systemic TLT. Before and after cardiac catheterization, the telemetric ECG monitoring was performed using AstroCard Telemetry system (Meditec, Russia). During the study, two groups of patients were formed. Group 1 included 85 patients (72.6%) without new ST-segment deviations on telemetry. 77 patients (90.6%) had no recurrent coronary artery thrombosis at angiography. Eight patients (9.4%) from group 1 were diagnosed with thrombosis of the infarct-related coronary artery. Group 2 included 32 patients (27.4%) who underwent TLT and then had ST-segment re-elevation episodes of 1 mV or more in the infarct-related leads, lasting for at least 1 minute. In group 2, in 27 of 32 patients (84.4%), thrombosis of the infarct-related coronary artery was confirmed (p<0.01 compared with group 1). In 71.9% cases, the recurrent ischemic episodes were asymptomatic (‘painless myocardial ischemia’) (p<0.01). Thus, in patients with STEMI and successful TLT, re-elevation of ST-segment during remote ECG monitoring is strongly related to angiographically documented coronary artery thrombotic reocclusion. The absence of chest pain during recurrent myocardial ischemia requires continuous ECG telemetry to select patients for the rescue percutaneous coronary interventions at an earlier stage.

  • coronary artery disease
  • coronary vessels
  • thrombosis
  • fibrinolysis
  • electrocardiography

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. Deidentified participant data are available from the coauthor ES.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. Deidentified participant data are available from the coauthor ES.

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Footnotes

  • Contributors VEO has suggested to apply the telemetric ECG for the diagnosis of coronary artery rethrombosis after effective thrombolytic therapy in patients with STEMI, and organized study conduction and described the pathogenesis of painless ischemia in STEMI. SM has drafted the manuscript and provided general governance of the study. ES has conducted the recruitment of patients with STEMI who underwent effective systemic thrombolytic therapy and subsequent percutaneous coronary intervention. She has singled out the criteria for the infarct-related artery rethrombosis and described the pathogenesis of painless ischemia in STEMI. AK has analyzed the results of coronary angiography and percutaneous coronary intervention. NB has conducted an analysis of the clinical symptomatology of STEMI in patients with infarct-related artery rethrombosis, and prepared a literature review on the issue of rethrombosis in STEMI. VEO is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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