Extent of ST-segment deviation in a single electrocardiogram lead 90 min after thrombolysis as a predictor of medium-term mortality in acute myocardial infarction

Schröder, Klaus; Wegscheider, Karl; Zeymer, Uwe; Tebbe, Ulrich; Schröder, Rolf

doi:10.1016/s0140-6736(01)06577-1

Cited by 113 publications

(75 citation statements)

References 30 publications

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“…Previous studies in patients treated with thrombolysis or primary percutaneous coronary intervention for AMI showed that the extent of the early ST-segment resolution correlates with the angiographic flow to the infarct area, 7,8 the enzymatic 9 and scintigraphic final infarct size, 10 the left ventricular function, and clinical outcome. 7,8,11 We also found a good correlation between a greater STsegment resolution and a smaller scintigraphic final infarct size and better survival rate at 6 months. The group of patients with a greater ST-segment resolution had, in addition, a lower proportion of anterior infarctions and a smaller initial scintigraphic perfusion defect.…”

Section: Discussionsupporting

confidence: 68%

Early Resolution of ST-Segment Elevation Correlates With Myocardial Salvage Assessed by Tc-99m Sestamibi Scintigraphy in Patients With Acute Myocardial Infarction After Mechanical or Thrombolytic Reperfusion Therapy

et al. 2002

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Background-Early resolution of ST-segment elevation is an indicator of final infarct size and clinical outcomes. Whether this correlation is an expression of initial infarct characteristics or degree of myocardial salvage achieved with reperfusion therapy is unclear. Methods and Results-We prospectively included 243 patients with acute myocardial infarction (AMI) treated with either coronary stenting (122 patients) or thrombolysis (121 patients). Serial 12-lead electrocardiograms (ECG) were performed at baseline and 90 minutes after initiation of therapy. ST-segment resolution was defined as complete (Ն70%), partial (Ͻ70% to 30%), or no resolution (Ͻ30%). Paired technetium-99m sestamibi scintigraphic studies were performed to calculate the initial perfusion defect, final infarct size, and the proportion of initial defect salvaged with reperfusion (salvage index). ST-segment resolution correlated significantly with salvage index (Pϭ0.008), final infarct size (PϽ0.001), and 6-month mortality (Pϭ0.03). In the groups with complete, partial, and no resolution, salvage index was 0.54Ϯ0.32, 0.39Ϯ0.36, and 0.33Ϯ0.60; final infarct size was 12.5Ϯ12.0%, 20.0Ϯ13.9%, and 22.7Ϯ19.4% of the left ventricle; 6-month mortality was 2.4%, 6.2%, and 12.8%, respectively. After adjustment for baseline characteristics, ST-segment resolution was the second strongest predictor of salvage index (Pϭ0.007) after the type of reperfusion, stenting, or thrombolysis (Pϭ0.001); it was greater after stenting than after thrombolysis (PϽ0.001). Conclusion-Early resolution of ST-segment elevation in surface ECG correlates with myocardial salvage as assessed by scintigraphy in patients with AMI after reperfusion therapy. These data provide an explanation for the favorable prognostic value of the ST-segment resolution and support the use of this parameter to compare the efficacy of different reperfusion strategies.

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Section: Discussionsupporting

confidence: 68%

Early Resolution of ST-Segment Elevation Correlates With Myocardial Salvage Assessed by Tc-99m Sestamibi Scintigraphy in Patients With Acute Myocardial Infarction After Mechanical or Thrombolytic Reperfusion Therapy

et al. 2002

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“…5,28,29 Although the value before PCI was even less specific than ST-segment elevation resolution, a postprocedural ST-segment elevation Յ1 mm was slightly less sensitive but much more specific than STsegment resolution because it produced the largest area under the receiver-operating characteristic curve. Therefore, a high degree of ST-segment elevation resolution (and possibly a complete resolution) remains a valuable predictor of effective reperfusion but does not exclude a relatively unfavorable outcome in terms of infarct size and left ventric-ular EF.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, maximal postprocedural ST-segment elevation seems to be a very accurate and easily measurable ST marker of favorable PCI outcome with small infarct and preserved left ventricular EF, as demonstrated in previous studies in patients who were treated with thrombolysis. 28, 29 The combined use of pre-and postprocedural ST-segment elevation, as suggested by multivariate discriminant analysis, achieves good sensitivity but is still affected by poor specificity.…”

Section: Discussionmentioning

confidence: 99%

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ST-Segment Analysis to Predict Infarct Size and Functional Outcome in Acute Myocardial Infarction Treated With Primary Coronary Intervention and Adjunctive Abciximab Therapy

Sciagrà

Parodi

Migliorini

et al. 2006

The American Journal of Cardiology

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ST-segment resolution is used to classify the response to reperfusion therapy in acute myocardial infarction, but the possibility to predict outcome in individual patients is unclear, particularly in the setting of primary percutaneous coronary intervention (PCI) and abciximab therapy. We studied 213 patients who underwent successful revascularization with PCI. Maximal ST-segment elevation was measured before and 30 minutes after PCI. Patient outcome was defined on the basis of infarct size and left ventricular ejection fraction (EF) as derived from gated single-photon emission computed tomography that was acquired 1 month after infarction. . Using receiver-operating characteristic curve analysis, the optimal ST-resolution cutoff was >60%, with 77% sensitivity and 51% specificity for predicting favorable outcome. ST-segment elevation <4.5 mV before PCI was 80% sensitive and 48% specific, and ST-segment elevation <1 mV after PCI was 74% sensitive and 60% specific for predicting favorable outcome. Early decrease of ST-segment elevation has been demonstrated to be a marker of myocardial tissue level reperfusion and thus of revascularization success. [1][2][3][4] The prognostic implications of this marker in patients who have acute myocardial infarction are known. [1][2][3]5 Other studies have suggested a relation between ST-segment resolution and infarct size and/or postinfarction left ventricular function, but the usefulness of ST-segment changes for predicting infarct extent and severity in the patient population has been questioned. 6 -10 In recent years, important advances in the treatment of infarction have been introduced and an aggressive therapy, based on direct percutaneous coronary intervention (PCI) with stenting plus abciximab administration, is currently the most advanced approach to infarct treatment. 11-14 Although ST-segment resolution has been used to test these new therapeutic strategies, its relation to objective parameters of treatment results in the patient population has not been examined. This study evaluated the accuracy of the simplest and quickest approach to ST-segment elevation analysis, i.e., single-lead analysis before and 30 minutes after PCI, 4 in characterizing the outcome of patients with acute myocardial infarction and who underwent early PCI with direct stenting and adjunctive abciximab therapy, using as the reference 1-month scintigraphic infarct size and left ventricular ejection fraction (EF). MethodsStudy patients: Between January 2001 and September 2004, 213 consecutive patients (155 men; mean 65 Ϯ 12 years of age) who had acute myocardial infarction and underwent primary PCI with direct stenting and adjunctive abciximab therapy were studied at 1 month after the index infarction for the assessment of myocardial perfusion and left ventricular function with gated single-photon emission computed tomography. Inclusion criteria were chest pain that persisted Ͼ30 minutes and was associated with STsegment elevation Ն0.1 mV in Ն2 contiguous electrocardiographic leads, admission wit...

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“…ST-segment depression in leads V1 to V4 was used in case of posterior infarction. 16 STR was determined based on the ECG at the beginning and the end of the PCI procedure and at 30 minutes after arrival on the CCU (mean time 81±17 minutes after reflow of the culprit artery). Complete STR was defined as >70% STR or <70% without residual ST-segment elevation (<1 mm in non-anterior leads and <2 mm in anterior leads), while no STR was defined as <70% STR with residual ST-segment elevation.…”

Section: St-segment Resolutionmentioning

confidence: 99%

Early versus late ST-segment resolution and clinical outcomes after percutaneous coronary intervention for acute myocardial infarction

Zwaan¹,

Stoel²,

Roos-Hesselink³

et al. 2010

NHJL

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Extent of ST-segment deviation in a single electrocardiogram lead 90 min after thrombolysis as a predictor of medium-term mortality in acute myocardial infarction

Cited by 113 publications

References 30 publications

Early Resolution of ST-Segment Elevation Correlates With Myocardial Salvage Assessed by Tc-99m Sestamibi Scintigraphy in Patients With Acute Myocardial Infarction After Mechanical or Thrombolytic Reperfusion Therapy

Early Resolution of ST-Segment Elevation Correlates With Myocardial Salvage Assessed by Tc-99m Sestamibi Scintigraphy in Patients With Acute Myocardial Infarction After Mechanical or Thrombolytic Reperfusion Therapy

ST-Segment Analysis to Predict Infarct Size and Functional Outcome in Acute Myocardial Infarction Treated With Primary Coronary Intervention and Adjunctive Abciximab Therapy

Early versus late ST-segment resolution and clinical outcomes after percutaneous coronary intervention for acute myocardial infarction

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