Document Detail

Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty.
MedLine Citation:
PMID:  16003698     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Among patients with ST-elevation acute myocardial infarction, those with terminal QRS distortion (grade 3 ischemia) have higher mortality and larger infarct size (IS) than patients without QRS distortion (grade 2 ischemia). METHODS: We assessed the relation of baseline electrocardiographic ischemia grades to area at risk (AR) and myocardial salvage [100 (AR-IS)/AR] in 79 patients who underwent primary angioplasty for first ST-elevation acute myocardial infarction and had technetium Tc 99m sestamibi single-photon emission computed tomography before angioplasty (AR) and at predischarge (IS). Patients were classified as having grade 2 ischemia (ST elevation without terminal QRS distortion in any of the leads, n = 48), grade 2.5 ischemia (ST elevation with terminal QRS distortion in 1 lead, n = 16), or grade 3 ischemia (ST elevation with terminal QRS distortion in >2 adjacent leads, n = 15). RESULTS: Time to treatment was comparable among groups. AR was comparable among groups (38% +/- 20%, 33% +/- 23%, and 34% +/- 23%, respectively; P = .70). There were no differences among groups in residual myocardial perfusion (severity index 0.28 +/- 0.12, 0.29 +/- 0.16, and 0.30 +/- 0.15 in grades 2, 2.5, and 3 ischemia, respectively; P = .97). In contrast, there was a trend toward lower myocardial salvage (45% +/- 32%) in the grade 3 group than in the grade 2 (65% +/- 33%) and grade 2.5 (65% +/- 40%) groups ( P = .16). Salvage was dependent on time only in the grade 3 group. Spearman rank correlation coefficients between time to treatment and percentage salvage were 0.003 ( P = .99), -0.24 ( P = .38), and -0.63 ( P = .022) for grades 2, 2.5, and 3, respectively. CONCLUSIONS: Patients with grade 3 ischemia have rapid progression of necrosis over time and less myocardial salvage. This admission pattern is a predictor of myocardial salvage by primary angioplasty.
Therese Billgren; Charles Maynard; Timothy F Christian; Mohmmad A Rahman; Mahammad Saeed; Stephen C Hammill; Galen S Wagner; Yochai Birnbaum
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of electrocardiology     Volume:  38     ISSN:  0022-0736     ISO Abbreviation:  J Electrocardiol     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-08     Completed Date:  2005-11-10     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  187-94     Citation Subset:  IM    
Division of Cardiology, The University of Texas Medical Branch, Galveston, TX 77555, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Cohort Studies
Coronary Circulation / physiology
Disease Progression
Follow-Up Studies
Middle Aged
Myocardial Infarction / pathology*,  radionuclide imaging
Myocardial Ischemia / classification*,  radionuclide imaging,  therapy
Myocardium / pathology*
Patient Admission
Radiopharmaceuticals / diagnostic use
Retrospective Studies
Technetium Tc 99m Sestamibi / diagnostic use
Tomography, Emission-Computed, Single-Photon
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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