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Failure of Simple Clinical Measurements to Predict Perfusion Status after Intravenous Thrombolysis

ROBERT M. CALIFF, M.D.; WILLIAM O'NEIL, M.D.; RICHARD S. STACK, M.D.; LYNNE ARONSON, B.S.; DANIEL B. MARK, M.D., M.P.H.; SUSAN MANTELL, R.N.; BARRY S. GEORGE, M.D.; RICHARD J. CANDELA, M.D.; DEAN J. KEREIAKES, M.D.; CHARLES ABBOTTSMITH, M.D.; ERIC J. TOPOL, M.D., TAMI Study Group*
[+] Article and Author Information

Grant support: in part by NRSA training grant 5T 32 HL07101-09 from the National Institutes of Health; research grants HS-04873 and HS-05635 from the National Center for Health Services Research; research grant from the National Heart, Lung, and Blood Institute; training grant LM-07003 and grant LM-03373 from the National Library of Medicine; a grant from the Andrew W. Mellon Foundation, New York; and a grant from Genentech, Inc., San Francisco.

▸Requests for reprints should be addressed to Robert M. Califf, M.D.; Duke University Medical Center, Box 31123; Durham, NC 27710.


*See Acknowledgments for a list of participating institutes.▸From the Duke University Medical Center, Durham, North Carolina; University of Michigan Medical Center, Ann Arbor, Michigan; Riverside Methodist Hospital, Columbus, and Christ Hospital, Cincinnati, Ohio

Durham, North Carolina; Ann Arbor Michigan; and Columbus and Cincinnati, Ohio


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;108(5):658-662. doi:10.7326/0003-4819-108-5-658
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To determine whether coronary patency could be detected early during thrombolytic therapy, commonly used markers of perfusion were recorded in 386 patients with acute myocardial infarction treated with tissue plasminogen activator. Infarct artery angiography 90 minutes after initiation of therapy was used to determine perfusion status. Of patients with complete resolution of ST segment elevation before the angiogram, 96% (95% confidence interval, 79% to 100%) showed perfusion on the angiogram, and among those with partial improvement, 84% (95% confidence interval, 76% to 90%) showed perfusion, but these findings occurred in only 6% and 38% of patients respectively. When complete resolution of chest pain occurred before the angiogram, 84% of patients (95% confidence interval, 75% to 90%) showed perfusion, but this finding occurred in only 29% of patients. Although arrhythmias occurred frequently in the first 90 minutes of therapy, none were associated with a higher patency rate. No other factors predicted coronary patency. A logistic regression model showed 25% of patients with 90% or greater probability of patency, but 56% of patients with no ST segment or symptom resolution had patent arteries.

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