Continuously updated 12-lead ST-segment recovery analysis for myocardial infarct artery patency assessment and its correlation with multiple simultaneous early angiographic observations

Krucoff, Mitchell W.; Croll, Martha A.; Pope, James E.; Pieper, Karen S.; Kanani, Prapti; Granger, Christopher B.; Veldkamp, Rolf F.; Wagner, Beverly L.; Sawchak, Sharon; Califf, Robert M.

doi:10.1016/0002-9149(93)90729-v

Cited by 159 publications

(54 citation statements)

References 13 publications

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“…Krucoff M. W. et al описали возможности непрерыв-ного мониторирования ЭКГ в режиме online, акцен-тируя внимание на сокращении сроков оценки эффективности реперфузии и реокклюзии инфаркт-связанной коронарной артерии по оценке динамики сегмента ST. Этой же группой авторов доказана высо-кая прогностическая значимость мониторинга сег-мента ST в оценке эффективности реперфузии у 22 пациентов c ОКСпST [7,8].…”

Section: Discussionunclassified

“…Имеются сведения о ряде исследований, доказав-ших высокую чувствительность и специфичность преходящей динамики сегмента ST при непрерывном мониторинге с целью оценки эффективности репер-фузии, однако они проводились на ограниченном числе пациентов [8,[11][12][13][14][15]. В 1991г Dellborg M. et al показали, что с помощью непрерывной векторкардиографии с анализом дина-мики сегмента ST и вектора комплекса QRS из 21 пациента ОКСпST, получивших ТЛТ, удалось выявить 15 из 16 пациентов с успешной ТЛТ и 4 из 6 пациентов с продолжающейся окклюзией коро-нарной артерии, что было подтверждено данными ранней КАГ [12].…”

Section: Discussionunclassified

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Improvement of Rethrombosis Diagnostics in Steacs Patients With Use of Telemonitoring of Ecg

Олейников¹,

Shigotarova²,

Кулюцин³

et al. 2014

Russ J Cardiol

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Section: Discussionunclassified

Improvement of Rethrombosis Diagnostics in Steacs Patients With Use of Telemonitoring of Ecg

Олейников¹,

Shigotarova²,

Кулюцин³

et al. 2014

Russ J Cardiol

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“…They should be monitored for a minimum of 24 hours and until they remain event-free for 12 to 24 hours. The potential benefits in patients with acute MI include the ability to (1) assess patency of the culprit artery after thrombolytic therapy [57][58][59][60][61] ; (2) detect abrupt reocclusion after primary angioplasty 62 ; (3) detect ongoing ischemia (ie, failed reperfusion therapy), recurrent ischemia, and infarct extension; and (4) detect transient myocardial ischemia. ST-segment monitoring stud-ies of patients hospitalized with unstable angina show that although 80% to 90% of transient ischemic events are asymptomatic, they are nonetheless significant markers for unfavorable short-and long-term outcomes (Table 2).…”

Section: Patients In the Early Phase Of Acute Coronary Syndromes (St-mentioning

confidence: 99%

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

Drew

Funk

2006

Critical Care Nursing Clinics of North America

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Abstract-The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided. Key Words: AHA Scientific Statements Ⅲ pediatrics Ⅲ electrocardiography Ⅲ torsade de pointes Ⅲ myocardial infarction Ⅲ tachyarrhythmias Ⅲ ischemia Ⅲ antiarrhythmic agents Ⅲ long-QT syndrome S ince the introduction of electrocardiographic (ECG) monitoring in hospital units Ͼ40 years ago, 1 the goals of monitoring have expanded from simple tracking of heart rate and basic rhythm to the diagnosis of complex arrhythmias, the detection of myocardial ischemia, and the identification of a prolonged QT interval. During the same 4 decades, major improvements have occurred in cardiac monitoring systems, including computerized arrhythmia detection algorithms, STsegment/ischemia monitoring software, improved noisereduction strategies, multilead monitoring, and reduced lead sets for monitoring-derived 12-lead ECGs with a minimal number of electrodes. 2,3 Despite these advances in technology, the need for human oversight in the interpretation of ECG monitoring data is as important today as it was 40 years ago for the following reasons. First, cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity. As a result, numerous false alarms occur that must be evaluated by healthcare professionals so that overtreatment of patients will not occur. Examples of overtreatment are reported in the The American Heart Association makes every effort to avoid any actual or potential co...

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“…10 Since the coronary event rate in patients without known coronary artery disease is lower than 5%, 4 it has been ultimately proposed to perform immediate exercise testing in those low-risk patients admitted to the hospital because of chest pain. 17 Such an approach, however, is questionable, as some low-risk patients with a cardiac origin of their chest pain have a dynamic activity of the ST segment, 18,19 with most episodes of myocardial ischemia occurring in the absence of symptoms. 11,12 Therefore, standard 60 electrocardiography may miss ST changes when they are not associated with symptoms suggesting a cardiac origin.…”

Section: Commonly Used Diagnostic Toolsmentioning

confidence: 99%

Continuous 12‐lead st‐segment monitoring improves identification of low‐risk patients with chest pain and a worse in‐hospital outcome

Pelliccia

Cianfrocca

Marazzi³

et al. 2002

Clinical Cardiology

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Background: Various strategies have been proposed to improve diagnosis and triage of patients with chest pain at low risk, but uncertainty still exists on the optimal combination of diagnostic tools that should be used in this subset of patients. Hypothesis: The aim of this study was to evaluate the incremental benefit of continuous 12‐lead ST‐segment monitoring over that provided by conventional diagnostic tools in patients with chest pain. Methods: Of 232 consecutive patients referred because of chest pain, 52 were classified as low‐risk according to the Agency for Health Care Policy and Research unstable angina guidelines and observed for 12 h with serial cardiac enzymes and electrocardiograms (ECG) (every 3 h). All patients also underwent both echocardiography at entry and continuous 12‐lead ST‐segment monitoring during the observation period. Results: During a mean hospital stay of 3.7 days (range 1‐14 days), a benign outcome was observed in 37 patients (71%), whereas 15 patients (29%) had major cardiac events or recurrence of chest pain of ischemic origin. Addition of ST‐segment monitoring findings to baseline clinical data as well as to serial enzymes and ECG features added significant incremental prognostic value (p < 0.001). Multivariate analysis showed reproduction of pain by chest pressure (p < 0.05) and presence of ST‐segment changes (≥ 0.1 mV) during 12‐lead ST‐segment monitoring (p < 0.001) as independent predictors of a benign or unfavorable outcome. Conclusions: In low‐risk patients with chest pain, continuous 12‐lead ST‐segment monitoring provides significant incremental diagnostic and prognostic information to currently used clinical, enzymatic, and ECG data, and is helpful in identifying the subset of patients with a worse in‐hospital outcome.

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Continuously updated 12-lead ST-segment recovery analysis for myocardial infarct artery patency assessment and its correlation with multiple simultaneous early angiographic observations

Cited by 159 publications

References 13 publications

Improvement of Rethrombosis Diagnostics in Steacs Patients With Use of Telemonitoring of Ecg

Improvement of Rethrombosis Diagnostics in Steacs Patients With Use of Telemonitoring of Ecg

Practice Standards for ECG Monitoring in Hospital Settings: Executive Summary and Guide for Implementation

Continuous 12‐lead st‐segment monitoring improves identification of low‐risk patients with chest pain and a worse in‐hospital outcome

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