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Minimal ST-segment deviation: a simple, noninvasive method for identifying patients with a patent infarction-related
Howard A Cooper1, James A de Lemos, David A Morrow
1Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass 02115, USA. HACooper@partners.org
Insights
Minimal ST-segment deviation (MSTD) is a quick, noninvasive method to assess artery patency after myocardial infarction treatment. This simple ECG measurement accurately predicts a clear artery, potentially helping patients avoid unnecessary angiography.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Acute ST-elevation myocardial infarction (STEMI) requires timely reperfusion.
- Assessing infarction-related artery (IRA) patency noninvasively is crucial for guiding treatment after fibrinolysis.
- Current methods like sum of ST-segment resolution (sum-STRES) are time-consuming.
Purpose of the Study:
- To develop and validate a simple, rapid, noninvasive electrocardiogram (ECG)-based method to assess IRA patency 90 minutes after fibrinolytic administration in STEMI patients.
- To compare the predictive value of this new method against established ECG criteria.
Main Methods:
- Retrospective analysis of ECGs from 604 STEMI patients in the TIMI 14 trial.
- Measurement of ST-segment deviation in a single lead on the 90-minute post-fibrinolytic ECG, identifying Minimal ST-segment deviation (MSTD).
- Comparison of MSTD's predictive value for IRA patency (TIMI flow grade 2 or 3) with sum-STRES and other complex ECG methods.
Main Results:
- 63% of patients exhibited MSTD.
- MSTD demonstrated a 91% positive predictive value (PPV) for a patent IRA.
- MSTD identified 90% of patients with complete sum-STRES and was significantly faster to perform.
- Results were consistent for both inferior and anterior infarctions.
Conclusions:
- MSTD at 90 minutes post-fibrinolysis is a highly accurate indicator of IRA patency in STEMI.
- This simple ECG assessment can help identify patients who may not require emergent coronary angiography, streamlining care.
- MSTD offers a rapid, effective alternative for noninvasive assessment of reperfusion success.
Background:
Because rescue intervention may improve the outcome of patients who fail to achieve epicardial reperfusion after fibrinolytic administration for acute ST-elevation myocardial infarction (STEMI), simple noninvasive measures of infarction-related artery (IRA) patency are needed. The sum of ST-segment resolution (sum-STRES) has a high positive predictive value (PPV) for a patent IRA, but is quite time-consuming.
Methods:
We retrospectively developed a very simple assessment that requires only the measurement of ST-segment deviation in a single electrocardiographic lead on a single electrocardiogram (ECG) 90 minutes after fibrinolytic administration. The ECG obtained immediately before fibrinolytic administration was reviewed as a means of selecting the single lead with the greatest ST-segment deviation. The absolute magnitude of ST deviation was measured in this lead on the 90-minute ECG. Minimal ST-segment deviation (MSTD) was defined as < or =1 mm ST deviation for inferior infarctions and < or =2 mm ST deviation for anterior infarctions. We compared the predictive value of this method with established but more complex ECG methods using data from the Thrombolysis In Myocardial Infarction (TIMI) 14 trial of low-dose fibrinolytic with full-dose glycoprotein IIb/IIIa inhibition.
Results:
Of the 604 patients with an evaluable ECG and angiographic data, 383 (63%) had MSTD. The presence of MSTD had a positive predictive value (PPV) of 91% for a patent IRA (TIMI flow grade 2 or 3). Results were similar for inferior and anterior infarctions. MSTD was a means of identifying 90% of patients with complete sum-STRES. The PPV of MSTD compared favorably with that of standard measures of ST-segment resolution, but it required only a few seconds to perform.
Conclusions:
The presence of MSTD at 90 minutes after fibrinolytic administration indicates a very high likelihood of IRA patency. MSTD may be helpful in identifying patients with STEMI treated by means of fibrinolytics who could safely avoid emergent coronary angiography.