Early assessment of outcome by ST-segment analysis after thrombolytic therapy in acute myocardial infarction

Dißmann, Rüdiger; Schröder, Rolf; Busse, Ulrike; Appel, Mathias; Brüggemann, Thomas; Jereczek, Matthias; Linderer, T

doi:10.1016/0002-8703(94)90579-7

Cited by 23 publications

(14 citation statements)

References 29 publications

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“…15 The extent of early ST resolution as a prognostic indicator has been addressed in previous studies. [1][2][3][4][5][6]16,17 The assessment of early ST resolution could assist clinicians in the early identification of high-risk patients eligible for immediate intervention, such as rescue angioplasty. However, the predictive value of this early single assessment is limited by instability of STsegment evolution after fibrinolysis.…”

Section: Discussionmentioning

confidence: 99%

“…The overall interobserver agreement between ECG readers was 93.4%, indicating very good concordance between ECG readers. To minimize confounding factors that might influence the accuracy of assessment of ST-segment elevation, patients were excluded from this analysis if they had one of the following: (1) left bundle-branch block, paced rhythm, ventricular rhythm, poor-quality ECG at either baseline or 24 to 36 hours; (2) in-hospital reinfarction before a 24-to 36-hour ECG was obtained; and (3) missing baseline or 24-to 36-hour ECG. The final ECG substudy group consisted of 13 100 patients ( Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…1 Several studies have demonstrated that early complete resolution of the ST segment is associated with higher infarct-related artery patency, 1 smaller infarct size, [2][3][4] better left ventricular function, 2,3 and lower mortality rates at 21 to 35 days, 1,4,5 6 months, 2 and 6 years. 3 To date, most studies have evaluated the prognostic value of ST resolution as early as 60 minutes and up to 4 hours after fibrinolysis as a bedside marker of prompt recanalization of the infarct-related artery.…”

mentioning

confidence: 99%

“…3 To date, most studies have evaluated the prognostic value of ST resolution as early as 60 minutes and up to 4 hours after fibrinolysis as a bedside marker of prompt recanalization of the infarct-related artery. [1][2][3][4][5][6] However, little information exists regarding the utility of ST resolution assessed beyond 4 hours after fibrinolytic therapy in predicting 1-year mortality rates. Furthermore, the relation between the time to treatment and ST resolution at 24 to 36 hours and its impact on outcome have not been well studied.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Goodman

Chang

et al. 2001

Circulation

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“…8 More recent convergent data of Shah et al and Hohnloser et al demonstrated a 23-50% appearance of sudden sinus bradycardia in thrombolyzed patients with inferior MI using prourokinase or rt-PA, associated with angiographically patent right coronary arteries within the first 24 h. 21,22 Rarely, in the above referenced studies, has a reflex bradycardia also been described after anterior descending or circumflex artery reopening. 6,7,15 The present study constitutes the largest patients series of the occurrence of the BJR phenomenon reported to date. We showed a similar incidence of BJR after treatment with rt-pA in approximately 30% of patients, and the same relatively well-tolerated transient nonmenacing bradyarrhythmias amenable to volume expansion or atropine alone.…”

Section: Introductionmentioning

confidence: 90%

The bezold‐jarisch reflex in acute inferior myocardial infarction: Clinical and sympathovagal spectral correlates

Chiladakis

Patsouras

Manolis

2003

Clinical Cardiology

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SummaryBackground: The cardiodepressor Bezold-Jarisch reflex (BJR) in acute inferior myocardial infarction (AMI) is traditionally considered as an indicator of successful thrombolysis.Hypothesis: The study aim was to elucidate the role of the autonomic nervous system in the pathogenesis of a BJR response in patients with AMI by tracing spectral profiles of heart rate variability (HRV).Methods: We studied 32 patients who presented with BJR after starting intravenous thrombolysis for an inferior AMI. Spectral components of HRV were analyzed over the three specific 5-min periods preceding and following reflex activation. Clinically, the occurrence of BJR was correlated with the outcome of thrombolysis to achieve timely reperfusion and sustained coronary artery patency.Results: The BJR was associated with early reperfusion in 94% of the patients, and with benign transient bradyarrhythmias and patent Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow right coronary arteries in 89% of the patients. Spectral analysis revealed a characteristic pattern of a sympathetic predominance with an impending gradual vagal withdrawal up to the onset of BJR, as reflected by progressive increases in low-frequency and reciprocal changes in high-frequency powers.Conclusions: The BJR in inferior AMI represents a reliable prognosticator of timely reperfusion and sustained coronary patency. Stimulation of vagal afferents in response to sympathetic overactivity may be the underlying pathogenetic mechanism promoting a BJR response.

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The influence of the resolution of reciprocal ST segment changes on in-hospital complications of acute myocardial infarction after percutaneous coronary angioplasty

Bozat

Sarikamiş²,

Koca

et al. 1998

Cathet. Cardiovasc. Diagn.

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Early assessment of outcome by ST-segment analysis after thrombolytic therapy in acute myocardial infarction

Cited by 23 publications

References 29 publications

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

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

The bezold‐jarisch reflex in acute inferior myocardial infarction: Clinical and sympathovagal spectral correlates

The influence of the resolution of reciprocal ST segment changes on in-hospital complications of acute myocardial infarction after percutaneous coronary angioplasty

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