Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion.

Krucoff, Mitchell W.; Croll, Martha A.; Pope, James E.; Granger, Christopher B.; O’Connor, Christopher M.; Sigmon, Kristina N.; Wagner, Beverly L.; Ryan, Jill A.; Lee, K L; Kereiakes, Dean J.

doi:10.1161/01.cir.88.2.437

Cited by 153 publications

(30 citation statements)

References 51 publications

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“…20 Recanalization of the infarct vessel can be recognized by Ͼ50% STsegment recovery. 20,22,23 As shown in patient 1, however, this "absolute relative" calculation depends on the initial as well as the current ECG used for comparison. Thus, in patient 1, the 90-minute ECG was no different from the time 0 ECG, but it was Ͼ50% recovered from the much worsened peak ECG that evolved within the 90-minute window.…”

Section: Krucoff Et Al St-segment Recovery In Acute Myocardial Infarcmentioning

confidence: 99%

Clinical Utility of Serial and Continuous ST-Segment Recovery Assessment in Patients With Acute ST-Elevation Myocardial Infarction

et al. 2004

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A cute ST-segment-elevation myocardial infarction (STEMI) is a global source of mortality and morbidity and consequently is one of the most active areas of applied research. In the face of multiple reports of new combinations of medical and interventional therapies, the challenge to the clinician is both to understand data from key clinical trials and to translate that understanding to the individual patient at the bedside.STEMI is defined by "ST elevation" on the ECG, which is the electrical manifestation of the pathophysiological changes that follow a thrombotic occlusion of an epicardial coronary artery. 1 The ECG is ubiquitous in cardiology, applied as a diagnostic, prognostic, and management tool. Although a single ECG presents about 10 seconds of waveform morphology, acute STEMI displays its dynamic behavior over time, both spontaneously and in response to therapy.The systematic use of serial and continuous ECG assessments has been one of the most fertile areas of advancement in the ability to measure and thereby recognize the presence, speed, quality, and stability of reperfusion of an infarct artery. In addition to providing insights into pathophysiological mechanisms and novel therapies in research protocols, serial or continuous use of this simple, noninvasive, quantitative measure has the potential to guide clinicians through the dynamic events surrounding the management of STEMI patients' disease. This is illustrated in the following case studies of 3 patients, all of whom presented with 3 hours of chest pain with angiographically documented Thrombolysis in Myocardial Infarction (TIMI) 3 flow, were managed with serial ECGs for clinical purposes, and were simultaneously monitored for research protocols with "black box" continuous 12-lead ECG monitors. Case Reports Patient 1G.E. was a 67-year-old man with a history of hypertension and tobacco use who presented with 3 hours of chest pain. The initial ECG showed anterolateral ST-segment elevation with a maximum of 15 mm of STsegment elevation in lead V 2 . He was treated with aspirin, heparin, and fulldose front-loaded tissue plasminogen activator. Although the patient had some pain relief, a repeat ECG 90 minutes later showed no interval change, with 15 mm of ST-segment elevation in lead V 2 . Acute angiography documented TIMI 3 flow through a 95% proximal left anterior descending coronary artery (LAD) stenosis, on which angioplasty was successfully performed. The patient subsequently did well. Figure 1 graphically shows the STsegment levels from continuously recorded 12-lead ECGs in this patient. In the 90 minutes between the first and second ECGs, ST-segment levels increased overall to a peak abnormality of 37-mm elevation in lead V 2 . Worsening condition from the time 0 ECG to these peak levels suggests ongoing occlusion of the infarct artery early after lytic therapy. By the 90-minute ECG, however, the 15-mm ST-

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Section: Krucoff Et Al St-segment Recovery In Acute Myocardial Infarcmentioning

confidence: 99%

Clinical Utility of Serial and Continuous ST-Segment Recovery Assessment in Patients With Acute ST-Elevation Myocardial Infarction

et al. 2004

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“…[9][10][11] It seems logical that continuous ECG monitoring would be a superior technique to the recording of static ECGs, and this technique has been quite exhaustively investigated. [12][13][14][15][16] Veldkamp and colleagues reported that continuous ST segment monitoring was at least as accurate as the most accurate of a number of static electrocardiographic methods, 17 and Zabel and colleagues found that the use of two static ECGs before and two hours after thrombolytic treatment had the same predictive value as continuous Holter monitoring with respect to thrombolysis induced coronary artery reperfusion. 18 Some investigators have described very specific and sensitive methods of detecting arterial patency using continuous ECG monitoring.…”

Section: Previously Described Ecg Criteria For Detection Of Failed Rementioning

confidence: 99%

Endomyocardial fibrosis associated with antiphospholipid syndrome

Azeem¹

2000

Heart

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Objective-To determine whether simple, readily applicable ECG criteria will allow early prediction of inadequate (< TIMI 3) flow in the infarct related vessel in patients receiving thrombolytic treatment for acute myocardial infarction; and to determine the success of streptokinase in achieving adequate antegrade flow in the infarct related vessel two hours after starting treatment. Design-Cohort study. Setting-Regional cardiothoracic unit. Patients-100 sequential patients with acute myocardial infarction. Interventions-Coronary angiography two hours after the initiation of thrombolytic treatment, proceeding to rescue angioplasty for inadequate flow in the infarct related vessel where appropriate. Main outcome measures-Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of six ECG criteria for the detection of inadequate antegrade flow in the infarct related vessel. Results-The ECG test that performed best as a positive test for < TIMI 3 flow in the infarct related vessel was < 50% resolution of the ST segment elevation in the worst lead and no accelerated idioventricular rhythm. This had a sensitivity of 81%, specificity of 88%, positive predictive value of 87%, negative predictive value of 83%, and overall accuracy of 85%. Conclusions-Sensitive, specific, and simple ECG criteria are defined for diagnosing failure of thrombolytic treatment with streptokinase. These allow the early detection of patients at high risk of further adverse events from a persistently occluded vessel. They may be used without recourse to sophisticated equipment or complex analyses. Such patients can then be considered for alternative treatments or enrolment into appropriate research protocols. (Heart 2000;84:149-156)

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“…In addition, rapid ST segment resolution is a reliable ECG indicator of reperfusion. 1) Several studies were carried out to estimate the ischemic area at risk or final infarct size with the admission ECG mainly by using the number of leads with ST deviation (elevation and/or depression) or the absolute amplitude of ST deviation. [2][3][4][5] However, the results are conflicting.…”

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confidence: 99%

The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

et al. 2004

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SUMMARYAlthough the damage in myocardial infarction has been demonstrated to be related with the magnitude and number of ST elevation, its relation with terminal distortion of QRS is unclear. The relationship between terminal QRS distortion in ECGs on admission and the results of early low dose dobutamine stress echocardiography (LDSE) performed 6 ± 2 days later was investigated.Patients admitted to our clinic within the first six hours of their chest pain and without a prior infarction diagnosis were divided into two groups based on the admission electrocardiogram as the absence (QRS-, n = 33) or presence (QRS+, n = 29) of distortion of the terminal portion of the QRS in ≥ 2 leads (QRS+; J point at > 50% of the R wave amplitude in lateral leads or presence of ST elevation without S wave in leads V 1 -V 3 ).There were no significant differences between the groups with respect to thrombolytic therapy or reperfusion criteria. During LDSE, the infarct zone wall motion score index (WMSI) in the QRS-group was significantly decreased relative to baseline (from 2.93 ± 0.65 to 2.37 ± 0.84, P = 0.02), and it was significantly different compared with WMSI in the QRS+ group (P = 0.005). Improvement of akinetic regions to hypokinetic regions in the infarct zone (IZ) was found to be 33.5% (44/131) in the QRS-group and 17.8% (27/ 151 P = 0.004) in the QRS+ group. Furthermore, 55.1% (10/29) of the patients in the QRS+ group and only 18.1% (6/33) of those in the QRS-group did not respond to LDSE (P < 0.05). In multiple logistic regression analysis, while there was no relationship between good left ventricular functions (WMSI < 2) and terminal QRS distortion under basal conditions (P = 0.07), an independent relation was observed to exist between them after LDSE (P = 0.03, OR 4.48, 95% CI, 1.13-17.7). Moreover, plasma CK levels were higher in the QRS+ group (P = 0.03), whereas the ejection fraction was worse (P = 0.01). In both groups, there was no correlation between the Selvester score and left ventricle WMSI at baseline, but this correlation was significantly improved with LDSE (QRS-; r = 0.39 P = 0.02 and QRS+; r = 0.44 P = 0.01)From the

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Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion.

Cited by 153 publications

References 51 publications

Clinical Utility of Serial and Continuous ST-Segment Recovery Assessment in Patients With Acute ST-Elevation Myocardial Infarction

Clinical Utility of Serial and Continuous ST-Segment Recovery Assessment in Patients With Acute ST-Elevation Myocardial Infarction

Endomyocardial fibrosis associated with antiphospholipid syndrome

The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

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