Circulation, Vol 88, 437-446, Copyright © 1993 by American Heart Association
MW Krucoff, MA Croll, JE Pope, CB Granger, CM O'Connor, KN Sigmon, BL Wagner, JA Ryan, KL Lee and DJ Kereiakes
BACKGROUND. If a practical, reliable, noninvasive marker of failed
reperfusion was available in real time, the benefits of further therapy in
this patient subgroup could be tested. We developed a method of 12- lead
ST-segment recovery analysis using continuously updated reference points to
provide such a marker. METHODS AND RESULTS. In this study, our method was
prospectively tested in 144 patients given thrombolytic therapy early in
myocardial infarction. All patients had 12-lead continuous ST-segment
monitoring and acute angiography, each analyzed in an independent, blinded
core laboratory. ST-segment recovery and re- elevation were analyzed up to
the moment of angiography, at which time patency was predicted. Predictions
were correlated to angiographic infarct artery flow, with TIMI flow 0 to 1
as occluded and TIMI flow 2 to 3 as patent. Infarct artery occlusion was
seen on first injection in 27% of patients. The positive predictive value
of incomplete ST recovery or ST re-elevation by our method was 71%,
negative predictive value 87%, with 90% specificity and 64% sensitivity for
coronary occlusion. ST recovery analysis predicted patency in 94% of
patients with TIMI 3 flow versus 81% of patients with TIMI 2 flow and
predicted occlusion in 57% of patients with collateralized occlusion versus
72% of patients with non-collateralized occlusion. In a regression model
including other noninvasive clinical descriptors, ST recovery alone
contained the vast majority of predictive information about patency.
CONCLUSIONS. In a blinded, prospective, angiographically correlated study
design, 12-lead continuous ST-segment recovery analysis shows promise as a
practical noninvasive marker of failed reperfusion that may contribute
substantially to currently available bedside assessment. Our data also
suggest that patients with TIMI 2 flow or with collateralized occlusions
may represent a physiological spectrum definable with ST-segment recovery
analysis.
ARTICLES
Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
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