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Circulation, Vol 82, 1147-1158, Copyright © 1990 by American Heart Association
JL Willems, RJ Willems, GM Willems, AE Arnold, F Van de Werf and M Verstraete
To determine the ability of initial ST segment elevation and depression to
predict infarct size limitation by thrombolytic therapy, data were analyzed
in 721 patients with acute myocardial infarction who were admitted to a
randomized, placebo-controlled study of intravenous recombinant tissue-type
plasminogen activator. Patients with QRS duration of 120 msec or more or
with previous history of myocardial infarction were excluded, leaving 322
in the treatment and 333 in the placebo group. Cumulative 72-hour release
of alpha-hydroxybutyrate dehydrogenase and global ejection fraction as well
as left ventricular wall motion derived from angiography were used as
independent measures of infarct size. Electrocardiograms obtained at
admission, 6 hours after start of therapy, and before discharge were
analyzed. All ST measurements were made by hand at the J point and 60 msec
after the J point. Patients with high ST segment elevation at admission
(i.e., sum of ST elevation at 60 msec after the J point was 20 mm or more)
had significantly larger infarction and higher hospital mortality when
compared with those with lower (less than 20 mm) ST elevation. Reciprocal
ST segment depression also showed a linear relation with infarct size and
mortality, independent from ST elevation, both in anterior and inferior
myocardial infarction. The sum of deviations measured at the J point and 60
msec after the J point differed significantly, especially in anterior
myocardial infarction at admission (mean, 16 +/- 9 versus 23 +/- 11 mm).
The prognostic value of one measurement was not, however, superior over the
other. Treatment with recombinant tissue-type plasminogen activator was
most effective in those with large ST deviations at admission, but patients
with anterior infarction and smaller ST shifts also appeared to benefit
from therapy. Results in individual patients were variable, and the overall
correlation of initial ST shifts with enzymatic infarct size was rather
low. In conclusion, the present study shows that the magnitude of initial
ST elevation and also of reciprocal ST depression in the admission
electrocardiogram is valuable for the management and assessment of
thrombolytic therapy in patients with acute myocardial infarction.
ARTICLES
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
Division of Medical Informatics, University of Leuven, Belgium.
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