Khan Ashar, Nadeem Shoeb, Kokane Hemant, Thummar Ankur, Lokhandwala Yash, Mahajan Ajay U, Nathani Pratap J
Resident in Cardiology, Department of Cardiology, LTMMC & GH, Sion, Mumbai, India.
Resident in Cardiology, Department of Cardiology, LTMMC & GH, Sion, Mumbai, India.
Indian Heart J. 2016 May-Jun;68(3):302-5. doi: 10.1016/j.ihj.2015.09.023. Epub 2016 Jan 12.
Accelerated idioventricular rhythm (AIVR) is a common arrhythmia observed in patients with ST segment elevation myocardial infarction (MI). It is not clear how much value AIVR has in predicting successful reperfusion, since there have been conflicting data regarding this in the past. Streptokinase (STK) even today is the commonest thrombolytic agent used in the public health care set-up in India.(1) Most data for the use of STK are from the 1990s, which had showed that at best it is effective in only 50% of patients in restoring adequate flow.(2) It is probable that with the current dual-antiplatelet loading dose regimen and other newer medications, this figure could be higher. Also, rescue angioplasty for failed thrombolysis is the standard of care now, unlike before. Hence, we need reliable non-invasive markers to judge successful reperfusion in the present era. While ST segment resolution is the standard marker for reperfusion used in thrombolytic trials, in several instances it is not definitive. An additional marker would thus be very useful, especially in such cases.
This was a prospective observational study carried out at a public teaching hospital. 200 consecutive patients with a diagnosis of acute MI who were given STK within 12h of index pain were included. The STK dose was 1.5 million units, infused over 30min; the ECG was again recorded after 90min of completion of the infusion. Continuous ECG monitoring for the first 24h of ICCU stay was performed and AIVRs during this period were documented. Early AIVR was defined as that occurring within 2h of completing the STK infusion. Echocardiography was performed 24h after presentation. The time course of AIVR was studied vis-a-vis the outcome of thrombolysis.
AIVR was seen in 41% of the patients. Though AIVR was found to have low sensitivity (45%) and specificity (64%) as a predictor of successful thrombolysis, early AIVR was a reliable sign of successful thrombolysis (p<0.05). The sensitivity (45%) of early AIVR was low; however, the specificity (94%) and positive predictive value (94%) were very good.
AIVR is a common arrhythmia in the setting of STEMI receiving thrombolytic therapy. Early AIVR is more common with successful thrombolysis, with an excellent positive predictive value. Thus, early AIVR can be used as an additive criterion to ST segment resolution as a non-invasive marker of successful thrombolysis with STK.
加速性室性自主心律（AIVR）是ST段抬高型心肌梗死（MI）患者中常见的心律失常。目前尚不清楚AIVR在预测再灌注成功方面有多大价值，因为过去关于这方面的数据存在矛盾。即使在今天，链激酶（STK）仍是印度公共卫生保健机构中最常用的溶栓药物。（1）大多数关于STK使用的数据来自20世纪90年代，这些数据表明，它最多只能使50%的患者有效恢复足够的血流。（2）随着目前的双联抗血小板负荷剂量方案和其他新型药物的应用，这一数字可能会更高。此外，与以前不同，现在对于溶栓失败的患者，补救性血管成形术是标准的治疗方法。因此，在当今时代，我们需要可靠的非侵入性标志物来判断再灌注是否成功。虽然ST段回落是溶栓试验中用于评估再灌注的标准标志物，但在某些情况下并不明确。因此，额外的标志物将非常有用，尤其是在这种情况下。
这是一项在一家公立教学医院进行的前瞻性观察性研究。纳入200例在出现症状后12小时内接受STK治疗的急性心肌梗死患者。STK剂量为150万单位，在30分钟内输注完毕；输注结束90分钟后再次记录心电图。在冠心病重症监护病房（ICCU）住院的前24小时进行连续心电图监测，并记录在此期间出现的AIVR。早期AIVR定义为在完成STK输注后2小时内出现的AIVR。就诊后24小时进行超声心动图检查。研究AIVR的时间进程与溶栓结果的关系。
41%的患者出现了AIVR。虽然发现AIVR作为溶栓成功的预测指标，其敏感性（45%）和特异性（64%）较低，但早期AIVR是溶栓成功的可靠标志（p<0.05）。早期AIVR的敏感性（45%）较低；然而，其特异性（94%）和阳性预测值（94%）非常好。
AIVR是接受溶栓治疗的ST段抬高型心肌梗死患者中常见的心律失常。早期AIVR在溶栓成功时更常见，具有出色的阳性预测值。因此，早期AIVR可作为ST段回落之外的附加标准，作为STK溶栓成功的非侵入性标志物。
