Electrocardiographic prediction of coronary artery patency after thrombolytic treatment in acute myocardial infarction: use of the ST segment as a non-invasive marker.

Hogg, Karen; Hornung, R. S.; Howie, Catherine A.; Hockings, N.; Dunn, Francis G.; Hillis, W S

doi:10.1136/hrt.60.4.275

Cited by 106 publications

(30 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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“…22 In a small test population, Hogg and coworkers, using the lead with maximum ST segment deviation on the standard 12 lead ECG, found that a 50% reduction in ST elevation was 67% specific and 93% sensitive; however, perfusion criteria were not given. 23 Many other studies have been reported, using a diVerent percentage of ST segment resolution, usually in small patient groups and with a wide variation in the time between the ECG recording and the determination of the state of reperfusion. The strength of our study lies in its prospective nature, in the simplicity of using only the ECG lead with the highest ST segment elevation, the immediate coronary angiography after the second ECG, giving the correct perfusion status, and the rather large patient population with a 43% coronary artery patency.…”

Section: Incidence and Value Of The Different Non-invasive Indicesmentioning

confidence: 99%

Enlargement of cardiac rhabdomyoma and myocardial ischaemia during corticotropin treatment for infantile spasm

Hiraishi¹,

Iwanami²,

Ogawa³

2000

Heart

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Objective-To investigate the value of non-invasive reperfusion indices in acute myocardial infarction, avoiding the possible need for acute coronary angiography and subsequent angioplasty. Design-In a prospective angiographic study, seven potential ECG or clinical markers of reperfusion were analysed in 230 patients with acute myocardial infarction. In all patients two 12 lead ECGs were used: the ECG on admission and the ECG immediately before coronary angiography. Non-invasive markers of reperfusion determined just before coronary angiography were prospectively correlated to thrombolysis in myocardial infarction (TIMI) flow. Data analysis correlated these non-invasive indices with coronary flow (analysis A: TIMI 2-3 v TIMI 0-1 flow; analysis B: TIMI 3 v TIMI 0-2 flow). Results-A sudden decrease in chest pain was the most common sign of reperfusion (36%), followed by reduction in ST segment elevation by > 50% (30%), and the development of a terminal negative T wave (20%) in the lead with the highest ST segment elevation. Reduction in ST segment elevation by > 50% and the appearance of an accelerated idioventricular rhythm (AIVR) had the highest positive predictive value for reperfusion. For analyses A and B, the positive predictive values were 85% and 66% for resolution of ST segment elevation, and 94% and 59% for AIVR, respectively. The presence of three or more non-invasive markers of reperfusion predicted TIMI 3 flow accurately in 80% of cases. Conclusions-The prospective use of non-invasive indices of reperfusion is simple, practical, and can be of value in assessing coronary patency in patients admitted with acute myocardial infarction. Using these indices, discrimination between TIMI 0-1 and TIMI 2-3 flow can be made with good accuracy. However, TIMI 3 flow cannot be determined reliably. The use of such noninvasive indices depends on the goal of reperfusion. 1-4 Various non-invasive indices were found useful for determining coronary reperfusion, such as resolution of ST segment elevation, reduction in chest pain, and the appearance of certain arrhythmias. Most of these studies were done in small numbers of patients, and the interval between the noninvasive evaluation and the angiographic validation of reperfusion was variable. Many of the studies were retrospective. The prospective value of non-invasive indices of reperfusion is still unclear.Determination of the presence of coronary reperfusion through simple non-invasive tools is of obvious value in establishing successful thrombolysis and identifying spontaneous reperfusion in patients referred for percutaneous transluminal coronary angioplasty (PTCA). Acute intervention in the presence of reperfusion has not been shown to improve clinical outcome, and coronary angiography should be withheld in cases where non-invasive markers of reperfusion are of suYcient predictive value.5 6 When coronary blood flow has not been restored, emergency PTCA is likely to be helpful. [7][8][9][10] The value of intracoronary intervention in patients with thrombolysi...

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“…incidence of successful reperfusion following thrombolysis assessed non-invasively [52,53] , in the high or low baseline lipoprotein(a) groups or in the subsequent revascularization rates. There was no difference between baseline lipoprotein(a) concentrations in those with or without a history of previous angina or myocardial infarction [54] .…”

Section: Lipoprotein(a) -A Risk Predictor For Cardiac Mortality 1357mentioning

confidence: 99%

Lipoprotein(a) as a risk predictor for cardiac mortality in patients with acute coronary syndromes

Stubbs

Seed²,

Lane³

et al. 1998

European Heart Journal

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Aims Raised lipoprotein(a) concentrations are considered to be a risk factor for atherothrombotic diseases. We examined whether baseline concentrations were a risk factor for an adverse outcome in patients admitted with acute coronary syndromes. Methods and ResultsFive hundred and nineteen patients admitted with suspected acute coronary syndromes were studied and followed prospectively for a median of 3 years. The prognostic significance of a baseline lipoprotein(a) concentration of d30 mg . dl 1 or lower for subsequent cardiac death was assessed in patients with myocardial infarction (266) and unstable angina (197) and compared with other variables in regression models. In patients with myocardial infarction, a baseline lipoprotein(a) concentration of d30 mg . dl 1 was associated with a 62% increase in subsequent cardiac death compared to the lower concentration group (29·8% vs 18·6%, Log rank P=0·04). In a multivariate regression model a baseline lipoprotein(a) concentration of d30 mg . dl 1 retained its significance as an independent predictor of cardiac death (P=0·037). In patients with unstable angina, baseline concentrations of d7·9 mg . dl 1 were found to be significant predictors of cardiac death in univariate (P=0·021) and multivariate (P=0·035) regression models.Conclusion Baseline lipoprotein(a) concentrations in patients admitted with acute coronary syndromes are associated with an increased risk of cardiac death. For patients with myocardial infarction a concentration of d30 mg . dl 1 appears appropriate as a risk discriminator; for patients admitted with unstable angina, however, much lower concentrations of lipoprotein(a) appear to be prognostically important.

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Electrocardiographic prediction of coronary artery patency after thrombolytic treatment in acute myocardial infarction: use of the ST segment as a non-invasive marker.

Cited by 106 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

Enlargement of cardiac rhabdomyoma and myocardial ischaemia during corticotropin treatment for infantile spasm

Lipoprotein(a) as a risk predictor for cardiac mortality in patients with acute coronary syndromes

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