Estimates of myocardium at risk and collateral flow in acute myocardial infarction using electrocardiographic indexes with comparison to radionuclide and angiographic measures

Christian, Timothy F.; Gibbons, Raymond J.; Clements, Ian P.; Berger, Peter B.; Selvester, Ronald H.; Wagner, Galen S.

doi:10.1016/0735-1097(95)80011-5

Cited by 100 publications

(49 citation statements)

References 34 publications

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“…ST-segment elevation scores correlate closest with both radionuclide and angiographic measurement of collateral flow. 7 The degree of ST elevation is a reflection of the extent of myocardium at risk and is thought to explain the association between the extent of ST elevation during AM1 and a poor outcome. Previous evidence also shows that prolonged ST-segment elevation in the precordial leads during the evolution of anterior…”

Section: Limitations Of the Studymentioning

confidence: 99%

Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction

Guo

Yap

Chen

et al. 2000

Clinical Cardiology

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Background: It has been suggested that a specific pattern of electrocardiographic (ECG) changes following acute myocardial infarction (AMI), the so-called "tombstoning," predicts a poorer outcome, although the cause and associations of such changes are not known. To address the possible cause and implications, we correlated angiographic findings with tombstoning in patients following AMI. Methods:The study investigated 124 patients with AMI, whose ECGs were taken within 24 h of onset of symptoms and who subsequently underwent angiography. In this population, 24 ( 19%) patients had a definite tombstoning pattern on their admission ECG.Results: Compared with non-tombstoning ECGs, the significant differences in the tombstoning group are as follows: (1) All patients, including those with inferior infarction, had either total or partial occlusion of the left anterior descending (LAD) artery (100 vs. 44%, p

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Section: Limitations Of the Studymentioning

confidence: 99%

Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction

Guo

Yap

Chen

et al. 2000

Clinical Cardiology

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“…16 However, in patients undergoing reperfusion therapy the correlation between the Aldrich score and the size of the ischemic area at risk (assessed by pretreatment technetium Tc 99 m sestamibi scan or cardiac magnetic resonance imaging) was found to be weak. 17,18 Due to concomitant ischemia of segments that are opposite to each other, occasionally there is cancellation of the ischemic vector and attenuation of ST segment deviation in some segments. It is commonly believed that "anteroseptal" STEMI pattern (ST elevation limited to V 1 -V 3 ) represents a smaller infarct that "extensive anterior" STEMI pattern (ST elevation extension to V 4 -V 6 ) due to an occlusion of a short LAD coronary artery.…”

Section: The Ecg In Patients With Ongoing Typical Symptomsmentioning

confidence: 99%

The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document

Birnbaum

Nikus

Kligfield

et al. 2014

Noninvasive Electrocardiol

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The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V 1 -V 3 ) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V 1 -V 3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients. Ann Noninvasive Electrocardiol 2014;19(5):412-425noninvasive techniques-electrocardiography; Acute coronary syndrome; ischemia; ST elevation; ST depression; myocardial infarctionThe electrical activity of the heart, as depicted by the surface electrocardiogram (ECG) is affected by ischemia, reperfusion and presence of necrosis or scar. Therefore, the ECG has remained the most widely utilized ancillary tool, along with focused history taking and physical examination,

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“…11,12 The use of 99m Tc-sestamibi imaging as a measure of myocardial ischemia severity during coronary occlusion not only in the setting of acute coronary syndrome but also during controlled coronary artery occlusion as in our model, has been validated. 13 Furthermore, we recently demonstrated that the extent and severity of the defect in myocardial perfusion of the territory of the occluded artery are highly correlated with collateral flow reserve, which is a theoretically and clinically well validated index of collateral circulation calculated from coronary pressure during balloon occlusion and can be used for quantitative assessment of collateral blood flow in conscious humans. 14, 15 Pfisterer et al 16 studied 25 patients during elective PTCA of a single LAD lesion and found perfusion defects on occlusion images obtained using 99m Tc-sestamibi.…”

Section: Assessment Of Myocardial Perfusion During Coronary Angioplasmentioning

confidence: 99%

Evidence of a Cellular Protective Effect by Antecedent Angina Independent of Collateral Flow Recruitment During Coronary Angioplasty in Humans.

Matsuo

Watanabe

Segawa

et al. 2002

Circ J

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Estimates of myocardium at risk and collateral flow in acute myocardial infarction using electrocardiographic indexes with comparison to radionuclide and angiographic measures

Abstract: The initial standard 12-lead ECG can provide insight into myocardium at risk and, to a greater extent, collateral flow and can consequently provide some estimate of subsequent infarct size. However, the confidence limits for such predictors are wide.

Cited by 100 publications

References 34 publications

Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction

Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction

The Role of the ECG in Diagnosis, Risk Estimation, and Catheterization Laboratory Activation in Patients with Acute Coronary Syndromes: A Consensus Document

Evidence of a Cellular Protective Effect by Antecedent Angina Independent of Collateral Flow Recruitment During Coronary Angioplasty in Humans.

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