ST SEGMENT RESOLUTION AND PATENCY OF INFARCT RELATED ARTERY ON CORONARY ANGIOGRAPHY AFTER ACUTE MYOCARDIAL INFARCTION (Synopsis)

Synopsis on ST SEGMENT RESOLUTION AND PATENCY OF INFARCT RELATED ARTERY ON CORONARY ANGIOGRAPHY AFTER ACUTE MYOCARDIAL INFARCTION

Introduction / Background
INTRODUCTION / BACKGROUND Early resolution of ST-segment elevation is associated with an improved outcome after infarction in terms of (Thrombolysis In Myocardial Infarction)TIMI grade Flow and left ventricular LV function.1 Early administration of Streptokinase(SK) is associated with a better out come in patients with myocardial infarction (MI). Thrombolysis prevents approximately 20-30 deaths per 1000 patients treated, with a proportional reduction in mortality of up to 25% in certain subgroups.2 Early resolution of ST-segment elevation (ST-segment recovery) on the ECG has frequently been used to non invasively to predict infarct related artery patency 3,4 The specificity of the electrocardiogram in acute myocardial infarction is limited by large individual variations in coronary anatomy as well as by the presence of preexisting coronary artery disease5 The culprit vessel in inferior myocardial infarction may be either the right coronary artery (in 80 percent of the cases) or the left circumflex artery. Greater ST-segment elevation in lead III than in lead II and ST-segment depression of more than 1 mm in leads I and aVL suggest involvement of the right coronary artery rather than the left circumflex artery 5 ST-segment elevation in lead III is not greater than that in lead II, and there is an isoelectric or elevated ST segment in lead aVL which signifies involvement of Lt Circumflex artery 6 In myocardial infarction of the anterior wall, ST-segment elevation in leads V1, V2, and V3 indicates occlusion of the left anterior descending coronary artery. ST-segment elevation in these three leads and in lead aVL in association with ST-segment depression of more than 1 mm in lead aVF indicates proximal occlusion of the left anterior descending artery 7,8 A reduction in ST-segment elevation by more than 70 percent in the leads with maximal elevation is associated with the most favorable outcomes.9
Objectives
OBJECTIVE

To know the patency of the coronary arteries in terms of TIMI grade flow in patients with resolution or no resolution of ST segment following thrombolysis on coronary angiography

Material and Methods
Hypothesis
Study Design : Descriptive Study
Sample Size : 100 consecutive patients with acute myocardial infarction who will fulfill inclusion criteria will be included and base line data regarding history diagnosis and treatment will collected on a Performa
Sampling Method : and base line data regarding history diagnosis and treatment will collected on a Performa
Duration of Study : Three months
Inclusion Criteria
„X Acute Myocardial Infarction as a first presentation
„X Acute myocardial infarction was identified by the onset of typical chest pain lasting more than 30 minutes, unrelieved by sublingual nitrate, and associated with typical ST segment elevation on the standard 12 lead ECG. had 1 mm of ST-segment elevation in 2 contiguous leads (or 2 mm ST-segment elevation in leads V1 through V3) on the ECG.
„X Streptokinase (SK) with in 12 Hours of chest pain (Thrombolysis)
„X Coronary angiography will be performed during the same hospitalization
Exclusion Criteria
„X Cardiogenic shock
„X Confounding features on the pretreatment ECG (for example, bundle branch block);
„X No femoral arterial access;
„X Pregnancy;
„X Inability to give fully informed consent
Data Collection Procedure
Statistical Methods
STATISTICAL ANALYSIS
All the data collected will be entered on SPSS software version 12.0. Frequency variable will be generated. Cross tabulation of the variable of interest will be compiled, where appropriate. Chi-square test and t- test will be applied for qualitative and quantitative analysis¡¦s respectively to see the relationship between various variables. Cut off point for significance will be taken on p< 0.05 at 95% confidence interval. Power point soft ware will be used to present data in graphical form and Microsoft word will be used for final completion of research report








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