Assessment of

Sucessful Thrombolysis
- Dr. Akif Baig
• Clinical

• ECG

• Biomarkers

• Angiography
 Clinical assessment

• Relief of pain- subjective

• Resolution of hypotension

• Attaining electrical stability

• Resolution of ST-ELEVATION by at least > 50 %
after 90 min has good correlation with
angiographic reperfusion.

• measured 80 ms after the J point in the lead of

the 12 lead ECG with maximal ST elevation at
baseline
 ECG FINDINGS SUGGESTIVE OF
EFFECTIVE/SUCCESSFUL THROMBOLYSIS

• Sum of total ST elevation (small elevations), or single

lead with large ST elevation

• Persistent ST elevation after thrombolysis suggest still

occluded artery or slow flow or no flow phenomenon
because of micro vascular dysfunction with patent
infarct artery
• T wave inversion

• Early inversion of terminal portion of T wave in

association with ST resolution suggestive of
reperfusion and small infarct size and better
prognosis

• Recovery of R wave amplitude

• Disappearance of q wave
 Reperfusion arrhythmias

• AIVR(Accelerated idioventricular rythm)-

ectopic ventricular rhythm at rate of 60-120

• Sign of reperfusion seen up to 50% of patients

with reperfusion

• Sinus bradycardia associated with hypotension

seen in 25-65% of patients with RCA
reperfusion.
 Biochemical indices
• Successful reperfusion causes an earlier release of
biochemical indices of myocardial necrosis into
peripheral blood

• The serial measurement of several markers like creatine

kinase (CK), the CK-MB iso enzyme, troponin T, and
myoglobin

• A > 4-6-fold increase in the first 2 h after lytic therapy

can also signify reperfusion (sensitivity 85%, specificity
100%).
 What is successful thrombolysis
• For a level of
standardization both
clinically and for studies
flow in infarct related
artery according to TIMI
GRADING SYSTEM.
• Angiographic grading
method
 FAILURE OF THROMBOLYSIS
• Persistence of pain

• <50% ST-segment resolution at 60–90 min in ECG

• The presence of haemodynamic instability at any

time

• Electrical instability,

• Worsening ischemia with re ST elevation

FAILED THROMBOLYSIS