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ST variability during the first 4 hours of acute myocardial infarction predicts 1-year mortality
P Johanson1, K Swedberg, M Dellborg
1Clinical Experimental Research Laboratory, Sahlgrenska University, Hospital/Ostra, SE-416 85 Göteborg, Sweden. pj@hjl.gu.se
Insights
Early ST variability in acute myocardial infarction patients indicates poor outcomes. Reduced ST variability was observed with fibrinolysis, suggesting its benefit in improving patient prognosis.
Area of Science:
- Cardiology
- Medical Technology
Background:
- Achieving early and complete myocardial reperfusion is critical for acute myocardial infarction (AMI) treatment.
- A need exists for noninvasive, real-time monitoring of blood flow alterations in AMI patients.
- Recurrent ST-segment elevation is a known indicator of cyclic perfusion disturbances.
Purpose of the Study:
- To investigate the association between ST variability and patient outcomes in acute myocardial infarction.
- To determine if ST variability can serve as a real-time indicator of perfusion status.
Main Methods:
- Retrospective analysis of ST variability in 102 AMI patients.
- Patients were randomized to receive either recombinant tissue plasminogen activator (rt-Pa) or placebo.
- Continuous 24-hour monitoring using vectorcardiography was performed.
Main Results:
- Patients alive at one year (86%) exhibited significantly less ST variability in the initial four hours (4.3 vs. 7.1 episodes, P=0.007).
- A high number of ST episodes (≥6) correlated with a 31.3% one-year mortality rate, versus no mortality in those with no ST variability.
- Fibrinolytic therapy (rt-Pa) was associated with a reduction in ST variability.
Conclusions:
- Early, real-time detectable ST variability is linked to a worse prognosis in AMI patients.
- ST variability monitoring may offer valuable insights into myocardial perfusion and patient outcomes.
Background:
Early and complete myocardial reperfusion is the goal when treating a patient with acute myocardial infarction. To achieve this in each individual, an on-line, accurate, easily handled and preferably noninvasive technique to monitor flow alterations is needed. Recurrent ST-segment elevation has been shown to reflect cyclic disturbances in perfusion.
Methods:
We have retrospectively analyzed ST variability in 102 patients with acute myocardial infarction randomized to 100 mg of rt-Pa or placebo. Patients were monitored for 24 hours using vectorcardiography.
Results:
Patients alive at one year (86%) had significantly less ST variability during the first four hours: 4.3 versus 7.1 episodes, P = 0.007. Patients having six or more ST episodes showed a 31.3% one-year mortality as compared to no mortality in patients having no ST variability. Furthermore ST variability was reduced by fibrinolysis.
Conclusion:
Early ST variability detectable in real time is associated with worse outcome.