| Prognostic implications of TIMI flow grade in the infarct related artery compared with continuous 12-lead ST-segment resolution analysis. Reexamining the "gold standard" for myocardial reperfusion assessment. | |
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MedLine Citation:
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PMID: 10716469 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To compare the prognostic significance of reperfusion assessment by Thrombolysis in Myocardial Infarction (TIMI) flow grade in the infarct related artery and ST-segment resolution analysis, by correlating with clinical outcomes in patients with acute myocardial infarction (AMI). BACKGROUND: Angiographic assessment, based on epicardial coronary anatomy, has been considered the "gold standard" for reperfusion. The electrocardiogram (ECG) monitoring provides a noninvasive, real-time physiologic marker of cellular reperfusion and may better predict clinical outcomes. METHODS: Two hundred fifty-eight AMI patients from the Thrombolytics and Myocardia Infarction phase 7 and Global Utilization of Streptokinase tPA for Occluded coronary arteries phase 1 trials were stratified based on blinded, simultaneous reperfusion assessment on the acute angiogram (divided into TIMI grades 0 & 1, TIMI grade 2 and TIMI grade 3) and ST-segment resolution analysis (divided into: <50% ST-segment elevation resolution or reelevation and > or =50% ST-segment elevation resolution). In-hospital mortality, congestive heart failure (CHF) and combined mortality or CHF were compared to determine the prognostic significance of reperfusion assessment by each modality using chi-square and Fisher's Exact tests for univariable correlation and logistic regression analysis for univariable and multivariable prediction models. RESULTS: By logistic regression analysis, ST-segment resolution patterns were an independent predictor of the combined outcome of mortality or CHF (p = 0.024), whereas TIMI flow grade was not (p = 0.693). Among the patients determined to have failed reperfusion by TIMI flow grade assessment (TIMI flow grade 0 & 1), the ST-segment resolution of > or =50% identified a subgroup with relatively benign outcomes with the incidence of the combined end point of mortality or CHF 17.2% versus 37.2% in those without ST-segment resolution (p = 0.06). CONCLUSION: Continuous 12-lead ECG monitoring can be an inexpensive and reliable modality for monitoring nutritive reperfusion status and to obtain prognostic information in patients with AMI. |
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Authors:
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A Shah; G S Wagner; C B Granger; C M O'Connor; C L Green; K M Trollinger; R M Califf; M W Krucoff |
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Publication Detail:
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Type: Clinical Trial; Clinical Trial, Phase I; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 35 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2000 Mar |
Date Detail:
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Created Date: 2000-03-24 Completed Date: 2000-03-24 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 666-72 Citation Subset: AIM; IM |
Affiliation:
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Duke University Medical Center, Durham, North Carolina, USA. Shah7865@aol.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Flow Velocity Coronary Angiography Coronary Vessels / physiopathology* Electrocardiography, Ambulatory* Humans Middle Aged Myocardial Infarction / mortality, physiopathology*, therapy Plasminogen Activators / therapeutic use* Prognosis Reproducibility of Results Streptokinase / therapeutic use* Survival Rate Thrombolytic Therapy* |
| Chemical | |
Reg. No./Substance:
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EC 3.4.-/Streptokinase; EC 3.4.21.-/Plasminogen Activators |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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