Relationship Between Terminal QRS Distortion on the Admission Electrocardiogram and the Time Course of Left Ventricular Wall Motion in Anterior Wall Acute Myocardial Infarction

Tamura, Akira; Nagase, Kimiaki; Watanabe, Tôru; Nasu, Masaru

doi:10.1253/jcj.65.63

Cited by 13 publications

(6 citation statements)

References 23 publications

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“…Previous studies 15 16 23 have also shown that GI3 patients were older. Lower incidence of prior angina in GI3 may be associated with less myocardial protection by ischaemic preconditioning and may explain the difference in outcome between the groups, as suggested by Tamura et al 25 However, some, 15 25 but not all, 23 24 33 prior studies have shown that fewer patients with GI3 have a history of angina. Thus, lack of ischaemic preconditioning cannot fully explain the difference in prognosis between the GI2 and GI3 patients with STEMI.…”

Section: Discussionmentioning

confidence: 87%

Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial

Sejersten

Birnbaum

Ripa

et al. 2006

Heart

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Objective: To determine whether ischaemia grade (GI) on the presenting ECG and duration of symptoms can identify subgroups of patients who would derive more benefit than the general population of patients with ST segment elevation acute myocardium infarction (STEMI) from primary percutaneous coronary intervention (pPCI) over thrombolytic treatment (TT) in reducing mortality or reinfarction. Methods: 1319 DANAMI-2 (Danish trial in Acute Myocardial Infarction-2) patients were classified as having grade 2 ischaemia (GI2; ST segment elevation without terminal QRS distortion) or grade 3 ischaemia (GI3; ST segment elevation with terminal QRS distortion in > 2 adjacent leads), and were divided into early and late groups split by the median time (3 h) from symptom onset to treatment. Outcomes were 30-day mortality and reinfarction. Results: Mortality was significantly higher for GI3 than for GI2 (9.7% v 4.8%, p , 0.001) and doubled for patients presenting late (GI2: 6.0% v 3.3%, p = 0.01; GI3: 12.5% v 4.7%, p = 0.05). Overall mortality did not differ significantly between pPCI and TT; however, a 5.5% absolute mortality reduction was seen in GI3 treated early with pPCI (1.4% v 6.9%, p = 0.10). Reinfarction rate was particularly high among GI3 patients presenting late and treated with TT (12.2%). pPCI in such patients significantly reduced the rate of reinfarction (0%, p , 0.001). Logistic regression analysis showed that age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.06 to 1.12, p , 0.001), prior angina (OR 2.56, 95% CI 1.44 to 4.54, p = 0.001), heart rate (OR 1.03, 95% CI 1.01 to 1.04, p = 0.001) and GI3 (OR 1.91, 95% CI 1.06 to 3.44, p = 0.031) were independently associated with mortality, whereas the sum of ST segment elevation was not. Conclusions: GI3 is an independent predictor of mortality among patients with STEMI. Mortality increased significantly with symptom duration in both GI2 and GI3. pPCI may be especially beneficial for patients with GI3 presenting early, whereas patients with GI3 presenting late and treated with TT are at particular risk of reinfarction. P rimary percutaneous coronary intervention (pPCI) is considered to be superior to thrombolytic treatment (TT) for ST segment elevation acute myocardial infarction (STEMI). 1-3 All studies have shown significant reduction of the combined end point of death and reinfarction. However, although meta-analysis showed a significant reduction of mortality with pPCI, none of the individual studies was powered enough to show a significant difference in mortality. 4 In most studies few patients in the TT arm underwent catheterisation and PCI. 2 5 6 As PCI after TT reduces the risk of reinfarction and the need for reintervention, 1 7 8 and reinfarction is associated with high mortality, 9 it is still unclear whether the disadvantage of TT can be overcome by routine catheterisation and early revascularisation to reduce the risk of reinfarction and its associated mortality, as suggested by the recent GRACIA-1 (routine invasive strategy within 24 hours of th...

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Section: Discussionmentioning

confidence: 87%

Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial

Sejersten

Birnbaum

Ripa

et al. 2006

Heart

View full text Add to dashboard Cite

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“…Evolution or persistence of G3I from the pre-hospital to the pre-PCI ECG predicts larger infarct size and less myocardial salvage compared to patients with persisting G2I or with decreasing grade from G3I to G2I [7]. Furthermore, G3I predicts reduced left ventricular regional wall motion [11], lower ejection fraction and more left ventricular remodeling in STEMI patients treated with PCI [12].…”

Section: Introductionmentioning

confidence: 97%

Outcome of all-comers with STEMI based on the grade of ischemia in the presenting ECG

Koivula

Eskola

Viikilä

et al. 2018

Journal of Electrocardiology

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“…Grade1: Tall sharp T waves without ST segment elevation; GI2: ST segment elevation in >2 contiguous leads without terminal QRS deformation; and GI3: ST segment elevation with terminal QRS deformation in >2 contiguous leads. Previous studies have shown that patients with GI3 on the presenting ECG have a worse prognosis [ 11 – 14 ], larger infarct size [ 11 , 15 – 18 ], less benefit from TT [ 11 , 17 ] and less hibernation in the infarcted myocardium [ 19 ] than patients with GI2. The progression of necrosis develops much faster in GI3 than GI2 [ 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Grade of Ischemia, Success of Reperfusion, and Type of Thrombolytic Regimen

et al. 2015

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BackgroundThis study was aimed to determine whether the grade of ischemia can predict the success of reperfusion in patients treated with thrombolytic therapy (TT) for ST elevation myocardial infarction (STEMI).Material/MethodsWe enrolled 229 consecutive patients with diagnosis of STEMI and receiving TT. Patients were divided into 2 groups – grade 2 ischemia (GI2) and grade 3 ischemia (GI3) – according to initial electrocardiogram (ECG). As TT, fibrin-specific (tissue plasminogen activator (t-PA)) or non-fibrin-specific (streptokinase (SKZ)) regimens were used. Successful reperfusion was defined as >50% resolution of the maximal ST segment on 90-min ECG. We tried to evaluate whether the grade of ischemia could predict the success of reperfusion and if there were any differences in terms of successful reperfusion between different thrombolytic regimens.ResultsThe successful reperfusion rate was significantly higher in GI2 than GI3 (82.4% vs. 64.4% respectively, p=0.002). The success rate was lowest at anterior GI3 (55.8%). Although there was no significant difference between thrombolytic regimens in all groups (p=0.77), t-Pa was superior to SKZ in anterior GI3 (63,6% vs. 30%, p=0.061). In addition, in multivariate analysis, GI and infarct localization were found as independent predictors for successful reperfusion with TT (p=0.006 and p=0.042, respectively).ConclusionsIn the current study, we found that GI2 is an independent predictor for successful reperfusion in STEMI treated with TT. Fibrin specific regime should be preferred in anterior GI3.

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Relationship Between Terminal QRS Distortion on the Admission Electrocardiogram and the Time Course of Left Ventricular Wall Motion in Anterior Wall Acute Myocardial Infarction

Cited by 13 publications

References 23 publications

Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial

Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial

Outcome of all-comers with STEMI based on the grade of ischemia in the presenting ECG

The Relationship between Grade of Ischemia, Success of Reperfusion, and Type of Thrombolytic Regimen

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