Elsevier

American Heart Journal

Volume 138, Issue 3, September 1999, Pages 525-532
American Heart Journal

Continuous ST-segment monitoring associated with infarct size and left ventricular function in the GUSTO-I trial,☆☆,

https://doi.org/10.1016/S0002-8703(99)70156-0Get rights and content

Abstract

Background The aim of this study was to evaluate whether in patients with myocardial infarction, the intensity and duration of myocardial ischemia as measured by continuous ST monitoring are associated with infarct size and residual left ventricular function. Methods and Results The analyses included patients with myocardial infarction, receiving thrombolytic therapy, who were enrolled in the electrocardiographic substudy of GUSTO-I, monitored by a vector-derived 12-lead electrocardiographic recording system, and in whom either infarct size (defined as cumulative release of α-hydroxybutyrate dehydrogenase activity per liter of plasma over a 72-hour period [Q(72)]) or left ventricular ejection fraction (LVEF) was determined. With the use of linear regression analysis, we investigated the association of various ST-trend characteristics with Q(72) (206 patients) and with LVEF (180 patients). A higher area under the ST trend since thrombolysis until 50% ST recovery and a higher area under recurrent ischemic episodes (ST reelevations) were significantly associated with a higher Q(72), whereas only a higher area under recurrent ischemic episodes was significantly associated with a lower LVEF. These associations remained after adjusting for other patient characteristics such as age, sex, infarct location, and time to treatment. Conclusions These findings support the physiologic hypothesis that both the intensity and duration of myocardial ischemia (both reflected by the estimated areas under the ST-trend curve) determine myocardial damage and thus are associated with infarct size and ejection fraction in patients with acute myocardial infarction who receive thrombolytic therapy. (Am Heart J 1999;138:525-32.)

Section snippets

Patients

The GUSTO-I electrocardiographic ischemia monitoring substudy included patients from the GUSTO-I angiographic substudy7 and patients enrolled in the noninvasive part of the main study.6 In brief, patients were eligible for the GUSTO-I study up to 6 hours after the onset of chest pain, lasting at least 20 minutes, with ST-segment elevation at 60 ms after the J-point (J + 60 ms) ≥0.1 mV in 2 or more limb leads, or ST J + 60 ms ≥0.2 mV in 2 or more precordial leads.6 Patients were randomly

Results

Table II shows the descriptive statistics for the ST-segment monitoring characteristics for the patients with a Q(72) and with an LVEF assessment, separately.

. Median values and frequencies of characteristics of continuous ST-segment monitoring for both patient groups, with an infarct size [Q(72)] and with an LVEF assessment, separately

ST-segment monitoring characteristicsQ(72) n = 206LVEF n = 180
Peak ST level (mV)0.5 (0.3-0.7)0.4 (0.3-0.7)
Time to 50% ST recovery (min)45 (23-84)48 (24-86)
AUC

Discussion

This analysis from GUSTO-I evaluated the association of continuous ST monitoring characteristics with the enzymatic infarct size and residual left ventricular function in patients with acute myocardial infarction treated with thrombolytic therapy. Adjusted for various patient characteristics, the area under the ST trend until 50% ST recovery was significantly associated with a larger infarct size and lower LVEF, whereas the area under all recurrent ischemic episodes was associated with larger

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    From Julius Center for Patient Oriented Research, Utrecht University; the Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam; the Center of Clinical Decision Sciences, Department of Public Health, Erasmus University Medical School, Rotterdam; Thorax Center, University Hospital Rotterdam, Dijkzigt; and Cardialysis, Rotterdam, The Netherlands.

    ☆☆

    Reprint requests: K.G.M. Moons, PhD, Julius Center for Patient Oriented Research, University Hospital Utrecht, PO Box 80035, 3508 TA Utrecht, The Netherlands.

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