Noninvasive detection of coronary artery patency using continuous ST-segment monitoring

Krucoff, Mitchell W.; Green, Curtis E.; Satler, Lowell F.; Miller, Frederick C.; Pallas, Randolph S.; Kent, Kenneth M.; Negro, Albert A. Del; Pearle, David L.; Fletcher, Ross D.; Rackley, Charles E.

doi:10.1016/0002-9149(86)90730-7

Cited by 208 publications

(40 citation statements)

References 16 publications

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“…5 In our study, microvascular perfusion was assessed by means of ST-segment resolution on serial ECG and by measurement of early marker increases. Analysis of ST segments is established for noninvasive estimation of reperfusion success after thrombolytic therapy 22,23 but is less well documented after PCI. 24 -26 Recent evidence suggests that the degree of ST-segment resolution after thrombolytic therapy correlates not only with epicardial vessel patency but also with microvascular perfusion as assessed by myocardial contrast echocardiography.…”

Section: Microvascular Perfusionmentioning

confidence: 99%

Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction

et al. 2001

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Background-In ST-segment elevation myocardial infarction, a troponin T Ն0.1 g/L on admission indicates poorer prognosis despite early reperfusion. To evaluate the underlying reason, we studied the value of cardiac troponin T (cTnT) for prediction of outcomes, epicardial blood flow, and myocardial reperfusion after primary percutaneous intervention. Methods and Results-Patients (nϭ140) admitted within 12 hours after onset of symptoms were stratified by admission cTnT. Epicardial and myocardial reperfusion were graded by the TIMI score and by measurement of relative increases of myoglobin, cTnT, and creatine kinase (CK)-MB 60 minutes after recanalization, respectively. cTnT was positive in 64 patients (45.7%) and was associated with longer median time intervals to admission (5.5 versus 3.5 hours, PϽ0.001) and higher mortality rates after 30 days (12.5% versus 3.9%, Pϭ0.06) and 9 months (14% versus 3.9%, Pϭ0.005). cTnT independently predicted a 3.2-fold risk for incomplete epicardial reperfusion (Pϭ0.03). In addition, cTnT Ն0.1 g/L was associated with more severely impaired myocardial perfusion despite normal epicardial flow, as indicated by lower 60-minute ratios of myoglobin (2.6 versus 7.6, Pϭ0.007), cTnT (6.6 versus 29.2, PϽ0.001), and CK-MB (3.5 versus 21.4, Pϭ0.002) and a tendency for less resolution of ST-segment elevations (54% versus 60%, Pϭ0.08). Conclusions-cTnT

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Section: Microvascular Perfusionmentioning

confidence: 99%

Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction

et al. 2001

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“…18 The underlying cause of ST reelevation has been shown to be related to transient or sustained reocclusion 18,22 or evolution of repolarization abnormalities in areas of infarction. 23 Thus, assessment of ST resolution at 24 to 36 hours has an important prognostic utility beyond the initial period of thrombolysis and related instability.…”

Section: Fu Et Al Time To Treatment Influences St Resolution 2657mentioning

confidence: 99%

Time to Treatment Influences the Impact of ST-Segment Resolution on One-Year Prognosis

Goodman

Chang

et al. 2001

Circulation

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Background-Early ST resolution after reperfusion is a prognostic indicator in acute myocardial infarction. Little information exists regarding the prognostic utility of ST resolution beyond 4 hours after fibrinolysis. Furthermore, the relation between time to treatment, ST resolution at 24 to 36 hours, and 1-year outcome has not been well studied. Accordingly, we undertook a prospective ECG substudy in the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) trial to examine this. Methods and Results-Patients (nϭ13 100) were stratified into 3 ST-resolution categories, based on baseline and 24-to 36-hour ECGs: complete resolution (Ն70%) in 6698 (51.1%) patients, partial resolution (30% to 70%) in 4610 (35.2%) patients, and no resolution (Ͻ30%) in 1792 (13.7%) patients; 1-year mortality rate was 5.1%, 8.0%, and 9.7%, respectively (PϽ0.001). Among patients treated Ͻ2 hours after symptom onset, 55.6% had complete ST resolution, whereas 52.1% and 43% of patients treated between 2 to 4 hours and 4 to 6 hours, respectively, had complete ST resolution (PϽ0.001). Within each category of ST resolution, patients treated Ͻ2 hours had lower 1-year mortality rates as compared with patients treated between 2 to 4 hours or Ͼ4 hours (3.8% versus 5.2% and 6.6%, Pϭ0.002 in complete ST resolution; 5.7% versus 8.4% and 9.9%, Pϭ0.001 in partial ST resolution; 7.1% versus 8.7% and 13%, Pϭ0.006 in no resolution). The extent of ST resolution was closely and inversely correlated with 1-year mortality rates (rϭϪ0.963, PϽ0.001). Conclusions-ST resolution at 24 to 36 hours after fibrinolysis is influenced by time to treatment and inversely related to 1-year mortality rates. Time to treatment further differentiates between high-and low-risk patients and further highlights the importance of reducing time delay to initiation of fibrinolysis in acute myocardial infarction. (Circulation. 2001;

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“…1,2 Krucoff et al reported that the resolution of ST-segment elevation had only a sensitivity of 89% and a specificity of 82% for detection of IRA reperfusion. 22 Other reports also reveal that ST segment improvement is associated with only an 84% probability of reperfusion. 23 Furthermore, Bren et al established that although ST-segment improvement was documented more completely and rapidly in patients with reperfusion, the degree of ST change was not a sufficient parameter for guiding clinical decisions.…”

Section: Comparison Of Mdct With Classical Noninvasive Predictors Formentioning

confidence: 98%

Multidetector Row Computed Tomography Noninvasively Assesses Coronary Reperfusion After Thrombolytic Therapy in Patients With ST Elevation Myocardial Infarction

Shin¹,

Won²,

Chang³

et al. 2006

Circ J

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BackgroundThe study objective was to assess the efficacy of 16-slice multidetector row computed tomography (MDCT) in estimating residual stenosis and successful reperfusion after thrombolysis in patients with ST-elevation myocardial infarction (STEMI). Methods and Results A total of 31 patients with STEMI underwent MDCT scanning within 6 h (mean 4.6± 1.1) after thrombolysis and the results for detection of significant residual stenosis and distal flow of the infarctrelated artery were compared with those from conventional coronary angiography (CCAG) performed within 24 h (mean 12.1±5.6) after the MDCT scan. Successful reperfusion was defined as Thrombolysis In Myocardial Infarction flow 2 or 3 on CCAG and full contrast enhancement of the distal artery landmarks on MDCT. A final analysis was performed using 24 patients (312 segments). MDCT had a positive predictive value of 73.3% and a negative predictive value of 95.1% for detecting significant residual stenosis. It accurately estimated 17 of 18 patients (94.4%) with successful reperfusion and 5 of 6 (83.3%) with failed reperfusion on the basis of comparison with CCAG. Conclusions MDCT demonstrated high accuracy not only for the detecting residual stenosis, but also for assessing successful reperfusion after thrombolytic therapy in patients with STEMI. (Circ J 2006; 70: 1590 -1597

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Noninvasive detection of coronary artery patency using continuous ST-segment monitoring

Cited by 208 publications

References 16 publications

Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction

Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction

Time to Treatment Influences the Impact of ST-Segment Resolution on One-Year Prognosis

Multidetector Row Computed Tomography Noninvasively Assesses Coronary Reperfusion After Thrombolytic Therapy in Patients With ST Elevation Myocardial Infarction

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