In the treatment of an acute ST-elevation MI, there are three major signs of successful reperfusion:
T-wave inversion within the first 4 hours. If the T-wave inversions occur beyond 4 hours, it's uncertain.
Resolution of the STE by at least 70% in the lead with maximal STE.
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.
