Potential significance of spontaneous and interventional ST-changes in patients transferred for primary percutaneous coronary intervention: observations from the ST-MONitoring in Acute Myocardial Infarction study (The MONAMI study)

Abstract

STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.

ST-segment dynamics during reperfusion period and the size of myocardial injury in experimental myocardial infarction

“…In clinical settings the extent of ST-resolution and the time to ST-resolution are usually assessed on the basis of discrete ECG strips only. Limited studies using 12-lead continuous ECG monitoring in the settings of STEMI have reported occurrence of short-term ST elevation exacerbation followed by the complete ST resolution during reperfusion achieved by either thrombolytic therapy (24) or percutaneous coronary intervention (PCI) (11,25). Thereafter the ST elevation gradually decreased towards complete resolution.…”

Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography

“…Terkelsen et al, using continuous ST monitoring, found spontaneous ST‐resolution in 22 of 92 patients (24%) with STE‐ACS before primary PCI 12. Most studies assessed only angiographic markers of SR and demonstrated that in patients undergoing mechanical reperfusion, a patent infarct‐related artery on the initial angiogram is associated with better outcomes 3, 6, 13.…”

Continuous ST-Segment Monitoring: Protocol for Practice

“…20 Several other investigators reported that using continuous ST-segment monitoring helped to predict patients' severity of disease at a variety of time points: during hospitalization, 19,21,22 after discharge, 23 and in long-term follow-up. 24 In the first study involving a comprehensive evaluation of ST-segment changes before, during, and after percutaneous coronary intervention, Terkelsen et al 25 performed continuous ST-segment monitoring in 92 patients with ST-elevation myocardial infarction, from ambulance through the percutaneous procedure until 90 minutes after the procedure. The results indicated that a prespecified ST-monitoring classification was useful for stratifying patients at the time of percutaneous coronary intervention into groups at low, intermediate, and high risk.…”

“…The results indicated that a prespecified ST-monitoring classification was useful for stratifying patients at the time of percutaneous coronary intervention into groups at low, intermediate, and high risk. Terkelsen et al 25 recommended use of continuous ST-segment monitoring for an early indication of the degree of reperfusion after percutaneous intervention.…”