Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. European Cooperative Study Group for Recombinant Tissue-Type Plasminogen Activator.

Willems, Jos L.; Willems, Rik; Willems, G. M.; Arnold, Alfred; Werf, Frans Van de; Verstraete, Marc

doi:10.1161/01.cir.82.4.1147

Cited by 146 publications

(30 citation statements)

References 36 publications

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“…[15][16][17][18][19][20][21][22][23][24][25][26] According to Peterson et al 25 , there is marginal correlation of magnitude of precordial depression of ST segment with the magnitude of elevation of ST segment in inferior AMI. Contrary to the above narrated studies, we observed that multivessel disease was more common in patients having depression of ST segment in leads V4-6 (83.6%) compared to 56.8% in Group I (V1-3) with acute inferior MI thus indicating the association of depression of ST segment in anterior leads with CAD.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

Abbas¹,

Riaz²,

Javaid³

et al. 2017

TPMJ

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ABSTRACT… Objectives:To determine the frequency of multivessel coronary artery disease (CAD) in patients suffering from inferior wall acute myocardial infarction (AMI) having ST segment depression in anterior chest leads. The presence of precordial ST depression during acute inferior wall myocardial correlates well with multivessel CAD. Precordial ST-segment depression in acute inferior wall MI is related to anterior injury due to LAD stenosis and these patients tend to have more severe CAD. Key words:Acute inferior wall myocardial infarction, ST segment depression, coronary angiography, multivessel coronary artery disease. Article Citation: Abbas S, Riaz R, Javaid I, Hameed N. Coronary artery disease; acute inferior wall myocardial infarction with ST segment depression in anterior chest leads. Professional Med J 2017;24(7):935-941.

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Section: Discussionmentioning

confidence: 99%

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

Abbas¹,

Riaz²,

Javaid³

et al. 2017

TPMJ

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“…With ST elevation during normal intraventricular conduction, higher ST-segment elevation is associated with larger potential infarct size and higher mortality, 3 and ST resolution at 60 to 90 minutes after fibrinolytic therapy predicts better outcomes. 4 -6 However, little information is available in patients with RBBB.…”

Section: Clinical Perspective P 789mentioning

confidence: 99%

Risk Stratification of Patients With Acute Anterior Myocardial Infarction and Right Bundle-Branch Block

et al. 2006

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on behalf of the Hirulog Early Reperfusion Occlusion (HERO-2) Investigators Background-Patients with an acute anterior ST-segment elevation myocardial infarction and right bundle-branch block (RBBB) have a high mortality risk, which may be stratified by early ECG changes. Methods and Results-In the Hirulog Early Reperfusion Occlusion (HERO-2) trial, 17 073 patients with acute myocardial infarction (AMI) within 6 hours of symptom onset were treated with streptokinase and randomized to receive bivalirudin or heparin. There was no difference in the primary end point of 30-day mortality. ECGs were recorded at randomization and 60 minutes after fibrinolytic therapy was begun. The 30-day mortality rate was 31.6% in the 415 patients with RBBB and anterior AMI at randomization and 33% in the 100 patients who developed new RBBB at 60 minutes from normal baseline conduction accompanying an anterior AMI. An increase in QRS duration by 20-ms increments was associated with increasing 30-day mortality rate in both RBBB groups on multivariable analyses with covariates of age, Killip class, systolic blood pressure, pulse, and prior infarction. Patients with QRS duration Ն160 ms had higher 30-day mortality rate than those with QRS duration Ͻ160 ms (37.2% versus 27.2%, Pϭ0.03, and 46.2% versus 24.5%, Pϭ0.025, in the 2 groups, respectively). For the patients with RBBB and anterior MI at randomization, RBBB resolved at 60 minutes in 40 patients, but 30-day mortality rate was unchanged.

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“…[18][19][20] Greater ST-segment elevation implies ongoing severe myocardial injury, and higher QRS scores imply broader transmural myocardial damage. In our study, patients who received statin pretreatment had a smaller magnitude of ST-segment elevation and lower QRS scores on admission as well as after reperfusion.…”

Section: Statins and Myocardial Damagementioning

confidence: 99%

Effects of Pretreatment With Statins on Infarct Size in Patients With Acute Myocardial Infarction Who Receive Fibrinolytic Therapy

Kiyokuni

Kosuge

Ebina

et al. 2009

Circ J

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Circ J 2009; 73: 330 -335 tatins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are widely used clinically to decrease serum cholesterol levels. 1 Recent studies have focused on the pleiotropic effects of statins, which are independent of their lipid-lowering effects, such as stimulation of fibrinolysis by altering the levels and activities of tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor-1. 2,3 Statins also reduce hemostasis by inhibiting platelet activation and the procoagulation cascade, and by augmenting the anticoagulation cascade. 4 Thus, statins appear to effectively enhance the fibrinolytic activity of t-PA. An experimental study in animals has shown that combination treatment with a statin and t-PA after stroke increases cerebral blood flow and reduces infarct volume as compared with fibrinolytic treatment alone; 5 however, data in humans are lacking. Prompt reperfusion of the occluded artery is crucial to limiting the size of an infarct. The present study was designed to test the hypothesis that statin treatment before the onset of acute myocardial infarction (AMI) contributes to prompt coronary artery reperfusion and smaller infarct size in patients with AMI who receive fibrinolytic therapy. We examined the relationship between statin pretreatment and the rate of coronary artery reperfusion assessed according to the Thrombolysis In Myocardial Infarction (TIMI) 6 flow grade and infarct size in patients with AMI who were given fibrinolytic therapy. The degree of myocardial damage before and after reperfusion therapy was also assessed on the basis of electrocardiographic (ECG) findings. Methods Study PopulationWe enrolled 310 consecutive patients with ST-segment elevation AMI (mean age 60±11 years; 268 men, 42 women) who fulfilled the following criteria: (1) no history of myocardial infarction; (2) admission to Yokohama City University Medical Center within 12 h of symptom onset; (3) absence of conditions precluding the evaluation of ST-segment changes on ECG (left or right bundle-branch block, ventricular pacing); and (4) received fibrinolytic therapy. The diagnosis of AMI was based on typical chest pain lasting at least 30 min, ST-segment elevation of at least 1 mm in 2 contiguous leads, and a subsequent increase in the serum creatine kinase (CK) level to more than twice the upper limit of normal. Cardiac symptoms occurring within 48 h before the onset of AMI were defined as preinfarction angina. 7 In Yokohama City University Medical Center, in principle, patients without any contraindications for fibrinolysis were given 200 mg oral aspirin, 50 IU/kg intravenous heparin, and (Received June 11, 2008; revised

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Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. European Cooperative Study Group for Recombinant Tissue-Type Plasminogen Activator.

Cited by 146 publications

References 36 publications

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

Coronary Artery Disease; Acute Inferior Wall Myocardial Infarction With St Segment Depression in Anterior Chest Leads

Risk Stratification of Patients With Acute Anterior Myocardial Infarction and Right Bundle-Branch Block

Effects of Pretreatment With Statins on Infarct Size in Patients With Acute Myocardial Infarction Who Receive Fibrinolytic Therapy

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