UMEM Educational Pearls

Category: Cardiology

Title: Acute MI Reperfusion

Keywords: acute myocardial infarction, reperfusion, ami (PubMed Search)

Posted: 10/7/2007 by Amal Mattu, MD (Updated: 8/11/2020)
Click here to contact Amal Mattu, MD

In the treatment of an acute ST-elevation MI, there are three major signs of successful reperfusion:

  1. T-wave inversion within the first 4 hours. If the T-wave inversions occur beyond 4 hours, it's uncertain.
  2. Resolution of the STE by at least 70% in the lead with maximal STE.
  3. Development of a "reperfusion arrhythmia," most notably accelerated idioventricular rhythm (AIVR), which looks like V.Tach but the rate is only 60-120. Remember, V.Tach should have a rate > 120.

Persistent pain/symptoms OR absence of STE resolution by 90 minutes warrants strong consideration of rescue angioplasty.