| Higher T-wave amplitude associated with better prognosis in patients receiving thrombolytic therapy for acute myocardial infarction (a GUSTO-I substudy). Global Utilization of Streptokinase and Tissue plasminogen Activator for Occluded Coronary Arteries. | |
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MedLine Citation:
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PMID: 9605045 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Increased T-wave amplitude is one of the earliest electrocardiographic (ECG) changes following coronary artery occlusion. Therefore, higher T waves in the presenting electrocardiogram should represent earlier time to treatment and thus be associated with lower mortality following thrombolytic therapy. However, T-wave amplitude has never been evaluated as a prognostic marker in this setting. We examined clinical outcomes in 3,317 patients with acute myocardial infarction (AMI) who underwent thrombolysis in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-I) Study. Patients were classified as either those with high T waves or those with low T waves. Higher T waves were defined as those >98th percentile of the upper limit of normal. T-wave amplitude was also evaluated as a continuous variable according to infarct location (maximum T-wave amplitude) and as the amount of excess T-wave amplitude above normal (excess T-wave amplitude). Patients with higher T waves had lower 30-day mortality than those without (5.2% vs 8.6%, p = 0.001) and were less likely to develop congestive heart failure (15% vs 24%, p <0.001) or cardiogenic shock (6.1% vs 8.6%, p = 0.023). Higher maximum T-wave amplitude and excess T-wave amplitude were predictive of lower 30-day mortality (chi-square = 67, p <0.001 and chi-square = 33, p <0.001, respectively). These differences remain significant after controlling for other prognostic baseline ECG variables. In addition, T-wave amplitude added prognostic significance after controlling for time to treatment. T-wave amplitude, an often-overlooked component of the electrocardiogram, can add significant prognostic information in initial evaluation of patients with AMI. |
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Authors:
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J Hochrein; F Sun; K S Pieper; K L Lee; K B Gates; P W Armstrong; W D Weaver; S G Goodman; E J Topol; R M Califf; C B Granger; G S Wagner |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of cardiology Volume: 81 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 1998 May |
Date Detail:
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Created Date: 1998-06-10 Completed Date: 1998-06-10 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1078-84 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Electrocardiography Female Heart Conduction System / physiopathology* Humans Logistic Models Male Middle Aged Multicenter Studies as Topic Myocardial Infarction / drug therapy*, physiopathology* Prognosis Randomized Controlled Trials as Topic Thrombolytic Therapy* |
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