Continuous ST-segment monitoring associated with infarct size and left ventricular function in the GUSTO-I trial☆,☆☆,★
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.
ST-segment monitoring characteristics Q(72) n = 206 LVEF 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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Cited by (21)
Detection of concurrent atrial ischemia with continuous monitoring of dynamic PR-segment changes in patients with acute myocardial infarction
2013, Journal of ElectrocardiologyCitation Excerpt :Several investigators have shown that continuous vectorcardiographic ST-segment monitoring provides valuable prognostic information in patients with unstable coronary syndromes. Its role in dynamic analyses of the ST-segment in the acute ventricular ischemia is unquestionable5,6 and it has been used also for P wave analysis.17 Here we used vectorcardiography for analysis of the PR-segment.
Randomized Comparison of Primary Percutaneous Coronary Intervention With Combined Proximal Embolic Protection and Thrombus Aspiration Versus Primary Percutaneous Coronary Intervention Alone in ST-Segment Elevation Myocardial Infarction. The PREPARE (PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation) Study
2009, JACC: Cardiovascular InterventionsCitation Excerpt :Yet, the intention-to-treat analysis showed a significantly higher immediate ST-segment resolution in favor of Proxis-treated patients and a significant reduction of overall injury current over time. While ST-segment recovery parameters are ultimately surrogate electrocardiographic biomarkers, they reflect intensity and duration of myocardial ischemia and have consistently been associated with infarct size, ejection fraction, and mortality in patients with myocardial infarction (2–4,25). Although the primary end point of ≥70% ST-segment resolution at 60 min and important secondary end points, such as MBG, were not statistically significant different between the 2 groups, there was a measurable effect very early with reperfusion that then equilibrated across groups over time.
Recombinant P-selectin glycoprotein ligand-immunoglobulin, a P-selectin antagonist, as an adjunct to thrombolysis in acute myocardial infarction. The P-Selectin Antagonist Limiting Myonecrosis (PSALM) trial
2006, American Heart JournalCitation Excerpt :Left ventricular ejection fraction, expressed as a percentage using the data from the left anterior oblique view (minimal overlap of the 2 ventricles), was calculated. Measurements of recovery of ST-segment elevation were correlated with tissue reperfusion.16,17 As many patients were found to have multiple periods of both ST-segment recovery and re-elevation early in infarction, apparently reflecting variations in cyclic flow of the infarct-related artery, 24-hour continuous 12-lead electrocardiogram recording was performed.18
Improved speed and stability of ST-segment recovery with reduced-dose tenecteplase and eptifibatide compared with full-dose tenecteplase for acute ST-segment elevation myocardial infarction
2004, Journal of the American College of CardiologyCitation Excerpt :Although frequently reported as measured between two serial static ECGs, analysis of static ST-segment resolution provides only a “snapshot” assessment of reperfusion that does not characterize the continuum of reperfusion (21,22). In contrast, continuous analysis of ST-segment recovery characterizes the entire process of reperfusion, and ST-segment recovery parameters correlate directly to preservation of left ventricular mechanical function, early re-infarction, and mortality (9–12,23). Even though continuous ST-segment monitoring analyses have demonstrated improved speed and stability of reperfusion with combination therapy, these findings did not translate into improved survival in large-scale trials evaluating pharmacologic combination reperfusion regimens (5,6,15,16,24).
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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.
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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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