Ischemic ST-segment episodes during the initial 24 hours of ST elevation myocardial infarction predict prognosis at 1
Per Ottander1, Johan B Nilsson, Steen M Jensen
1Department of Cardiology, Heart Centre, Umeå University Hospital, Umeå, Sweden. per.ottander@vll.se
Insights
Recurrent ischemic episodes within 24 hours of ST-elevation myocardial infarction (STEMI) predict long-term mortality. Continuous ST-segment monitoring identifies high- and low-risk STEMI patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomedical Engineering
Background:
- ST-elevation myocardial infarction (STEMI) poses significant mortality risks.
- Thrombolysis is a common treatment for STEMI.
- Early identification of high-risk patients is crucial for improved outcomes.
Purpose of the Study:
- To evaluate the prognostic significance of recurrent ischemic episodes in the first 24 hours post-thrombolysis for STEMI.
- To determine if these episodes can define a low-risk patient group.
Main Methods:
- Continuous online vectorcardiography was used to monitor 220 STEMI patients for 24 hours.
- Recurrent ischemic events were detected by assessing ST vector changes.
- ST-change vector magnitude (STC-VM) increase >50 muV for at least 2 minutes defined an event.
Main Results:
- Ischemic events between 4 and 24 hours predicted 5-year mortality (HR 1.18; 95% CI 1.01-1.37).
- Increased frequency of events correlated with poorer prognosis.
- A low-risk group with 1.9% 1-year mortality was identified.
Conclusions:
- Continuous ST-segment monitoring in the first 24 hours is valuable for risk stratification in STEMI.
- STC-VM events from 4 to 24 hours effectively predict long-term mortality after STEMI.
Objectives:
The aims of the study were to assess the prognostic value of recurrent ischemic episodes during the first 24 hours in ST elevation myocardial infarction (STEMI) treated with thrombolysis and to explore those episodes as a part of a low-risk prognostic feature.
Design:
Two hundred twenty patients with STEMI treated with thrombolysis were monitored for 24 hours with continuous online vectorcardiography assessing ST vector changes to record recurrent ischemic events.
Results:
Ischemic events measured as an increase in ST-change vector magnitude (STC-VM) more than 50 muV for at least 2 minutes during 4- to 24-hour predicted mortality in a 5-year follow-up based on a multivariable analysis (hazard ratio, 1.18/episode; confidence interval, 1.01-1.37). The more episodes there were, the worse the prognosis. A low-risk group with a 1-year mortality of 1.9% could be identified.
Conclusion:
Continuous ST-segment monitoring during the first 24 hours of a myocardial infarction is a valuable tool for identifying high- and low-risk patients. The STC-VM events during 4 to 24 hours of the first day of a myocardial infarction predict mortality within 5 years.
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