ST segment analysis for assessment of coronary artery patency: comparison of surface ECG and Holter recordings
M Zabel1, S H Hohnloser, A Parussel
1University of Freiburg, Department of Cardiology, Germany.
Insights
Surface ECGs and Holter monitoring show similar accuracy in predicting coronary artery reperfusion after myocardial infarction. However, neither method reliably predicts which patients need further intervention due to low negative predictive values.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Trials
Background:
- Acute myocardial infarction (AMI) requires timely reperfusion therapy.
- Assessing the success of thrombolysis and predicting coronary artery patency are crucial for patient management.
- Electrocardiography (ECG) methods are explored for non-invasive assessment of reperfusion.
Purpose of the Study:
- To compare the efficacy of Holter monitoring versus surface ECG recordings in assessing thrombolysis-induced ST segment changes in AMI patients.
- To evaluate the accuracy of both ECG methods in predicting infarct-related artery patency and reperfusion status.
Main Methods:
- A prospective trial involving 124 patients with acute myocardial infarction.
- Simultaneous Holter and surface ECG recordings were obtained.
- Angiography was performed 90 minutes post-thrombolysis to determine the gold standard for artery patency.
Main Results:
- Both Holter and surface ECG demonstrated comparable sensitivity, specificity, and positive predictive values (64-92%) for predicting perfusion status.
- The negative predictive value for both methods was low (40-53%).
- No significant differences were found between the two ECG methods in any evaluated parameter.
Conclusions:
- Two surface ECG recordings (pre- and 2-hour post-therapy) offer similar predictive value to continuous Holter monitoring for assessing coronary artery reperfusion.
- The low negative predictive value of ST segment analysis necessitates more advanced non-invasive methods for accurately triaging patients requiring early coronary interventions.
Abstract:
In a prospective trial in 124 patients with acute myocardial infarction, Holter and surface ECG recordings were obtained simultaneously and compared for their ability to assess thrombolysis-induced ST segment changes. Accuracy in predicting patency of the infarct-related artery was evaluated in both methods. Success or failure of thrombolysis was determined angiographically 90 min after the start of therapy. For both methods, sensitivity, specificity, and positive predictive value for correct prediction of the perfusion status ranged between 64% and 92%. However, the negative predictive value was considerably lower (40-53%). There were no significant differences in any parameter evaluated for either method. Thus, two surface ECG recordings before and 2 h after the start of therapy yield the same predictive value as continuous Holter monitoring with respect to thrombolysis-induced coronary artery reperfusion. However, for triage of patients to early coronary interventions, more sophisticated methods are needed for non-invasive prediction of coronary artery patency due to the low negative predictive value of ST segment analysis.
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin to...
01:24ECG Interpretation of Rhythms
Components of the Electrocardiogram
The primary components of a normal ECG waveform in Normal sinus rhythm(NSR) include the P wave, PR interval, QRS complex, ST segment, T wave, and occasionally a U wave.
ECG waveforms are divided by vertical and horizontal lines at standard intervals.
The horizontal axis measures time and rate, and the vertical axis measures amplitude or voltage. When...
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:23Holter Monitor: 24-Hour Monitoring
01:30Acute Coronary Syndrome III: Diagnostic Studies