High-risk subgroups of patients with non-Q wave myocardial infarction based on direction and severity of ST segment deviation

Willich, Stefan N.; Stone, Peter H.; Muller, James E.; Tofler, Geoffrey H.; Crowder, James A.; Parker, Corette B.; Rutherford, John D.; Turi, Zoltan G.; Robertson, Thomas; Passamani, Eugene R.; Braunwald, Eugene

doi:10.1016/0002-8703(87)90186-4

Cited by 60 publications

(15 citation statements)

References 38 publications

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“…In the pres ence of normal cardiac enzymes, ST depression probably reflects unstable angina, whereas ST elevation and T wave inversion may reflect other benign pathologies including pericarditis. Other studies have found that in patients with myocardial infarction, those with ST depression have a higher 1-year mortality than those with ST eleva tion [10,11]. A survivor bias may explain some of the differences, if patients with ST depression are more likely to survive the initial event and hospitalization, only to succumb to a major event later.…”

Section: Discussionmentioning

confidence: 99%

Can ECG Changes Predict the Long-Term Outcome in Patients Admitted to Hospital for Suspected Acute Myocardial Infarction?

Lim¹,

Kinlay²,

Fisher³

et al. 1997

Cardiology

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7,028 patients with suspected acute myocardial infarction and discharged alive from hospital were followed in a 10-year community-based study. The long-term prognosis was relatively good if the electrocardiograms (ECGs) were normal (5-year all-cause death rate 5%), poor with uncodable ECGs showing rhythm or conduction disturbances (37%), and intermediate with new Q wave, new ST elevation, new T wave inversion or ischemic ECG (17-21%), and with new ST depression (27%). Similar patterns were found for ischemic cardiac death and reinfarction. The long-term prognosis of patients with suspected acute myocardial infarction is relatively good if the ECGs are normal and poor if ECGs are uncodable. ST depression may be a marker for a worse long-term outcome.

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Section: Discussionmentioning

confidence: 99%

Can ECG Changes Predict the Long-Term Outcome in Patients Admitted to Hospital for Suspected Acute Myocardial Infarction?

Lim¹,

Kinlay²,

Fisher³

et al. 1997

Cardiology

View full text Add to dashboard Cite

show abstract

“…21) ST segment depression is considered as one of the most important predictors of recurrent angina pectoris, reinfarction, and death in ACS. 5) Nyman and colleagues reported that patients with unstable angina and NSTEMI having ST segment depression on baseline admission ECG were at highest risk for cardiac death, MI, and severe angina pectoris with a follow-up of one year. Patients with ST segment changes benefit 2-3 times more with GP IIb/IIIa inhibitors compared to patients with stable ST segments.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6] This study assessed the effect of tirofiban added to conventional treatment on ST segment resolution in NSTEMI patients. Sixty-four patients were randomized to one of the two groups: 32 patients received conventional treatment while tirofiban was added in the second group of 32 patients.…”

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confidence: 99%

“…3,4) It has been reported that ST segment depression is related to a high risk of MI and death in these patients. 5,6) Thus ST segment depression is a marker of increased risk but is also useful to discriminate patients likely to have greater benefit from aggressive antithrombotic and interventional therapy. 7,8) Recent clinical trials have shown that the addition of GP IIb/IIIa inhibitors consistently reduces the incidence of death and MI in patients with unstable angina or non-ST elevated myocardial infarction (NSTEMI).…”

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confidence: 99%

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The Effect of Tirofiban on ST Segment Resolution in Patients With Non-ST Elevated Myocardial Infarction

et al. 2004

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SUMMARYST segment resolution in ST elevated myocardial infarction has independent predictive value for congestive heart failure and death at 30 days.1-2) ST segment depression in unstable angina pectoris (UAP) and non-ST elevated myocardial infarction (NSTEMI) predicts high risk of MI and death and may discriminate patients likely to have greater benefit from aggressive antithrombotic and interventional therapy. [5][6] This study assessed the effect of tirofiban added to conventional treatment on ST segment resolution in NSTEMI patients. Sixty-four patients were randomized to one of the two groups: 32 patients received conventional treatment while tirofiban was added in the second group of 32 patients. In the first group, 6 patients refused to participate further after giving initial informed consent while 1 patient in the tirofiban group dropped out. We had 26 patients (mean age, 59 years) in the conventional treatment group and 31 patients (mean age, 59 years) received also tirofiban. Tirofiban was administered by intravenous infusion over a 72 hour period. More than 50% regression of depression was considered to be ST segment resolution.The characteristics of the two groups were comparable (Table I). The ST segment resolution evolution did not differ at the 4 th and 24 th hours between the two groups. Significant differences occurred in the 72 nd hour ECG (Table III). ST resolution was present in 67.9% of the tirofiban patients and in 32.1% of the conventional treatment group (P < 0.05).Tirofiban treatment was not associated with an increase in major bleeding even though there was a trend toward an increase in minor bleeding cases and did not influence the occurrence of refractory angina pectoris. (Jpn Heart J 2004; 45: 913-920)

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“…[1][2][3] However, those studies did not differentiate patients with ST-segment depression in the inferior leads from those with STsegment in the lateral chest leads. There may be differences in the significance between the 2 types of ST-segment depression and although there have been many reports with regard to ST-segment depression in the inferior leads in anterior wall AMI, 4-21 the angiographic and clinical significance of ST-segment depression in the lateral chest leads in anterior wall AMI has not yet been fully investigated, especially in the case of AMI accompanied by ST-segment elevation in the precordial leads.…”

mentioning

confidence: 99%

Angiographic and Clinical Significance of `Transient' ST-Segment Depression in the Lateral Chest Leads in Anterior Wall Acute Myocardial Infarction

et al. 1999

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High-risk subgroups of patients with non-Q wave myocardial infarction based on direction and severity of ST segment deviation

Cited by 60 publications

References 38 publications

Can ECG Changes Predict the Long-Term Outcome in Patients Admitted to Hospital for Suspected Acute Myocardial Infarction?

Can ECG Changes Predict the Long-Term Outcome in Patients Admitted to Hospital for Suspected Acute Myocardial Infarction?

The Effect of Tirofiban on ST Segment Resolution in Patients With Non-ST Elevated Myocardial Infarction

Angiographic and Clinical Significance of `Transient' ST-Segment Depression in the Lateral Chest Leads in Anterior Wall Acute Myocardial Infarction

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