Document Detail

Risk stratification in ST-elevation myocardial infarction is enhanced by combining baseline ST deviation and subsequent ST-segment resolution.
MedLine Citation:
PMID:  17932094     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The baseline sum of ST deviation (SigmaSTD) and ST segment resolution after fibrinolysis for ST-elevation myocardial infarction are prognostically useful. OBJECTIVES: To examine the prognostic impact of ST resolution after fibrinolysis and influence of baseline ST deviation in ASSENT-3. METHODS: ST resolution was determined in 4565 patients at 180 minutes after fibrinolysis. 30-Day and 1-year mortality was assessed in patients with complete (ie, > or =50%) versus incomplete ST resolution according to absolute baseline SigmaSTD. RESULTS: Patients with complete ST resolution had lower 30-day and 1-year mortality than those with incomplete ST resolution (3.7% vs 7.3%, p<0.001, and 6.1% vs 10.0%, p<0.001, respectively). After multivariable adjustment for key baseline risk factors, patients with anterior myocardial infarction (MI) in the highest quartile of SigmaSTD had a greater risk of 30-day and 1-year mortality than those in the lowest quartile in both complete (odds ratio (OR) = 2.34, 95% CI 1.14 to 4.80, and OR = 2.34, 95% CI 1.26 to 4.34, respectively) and incomplete ST resolution groups (OR = 4.97, 95% CI 1.82 to 13.61, and OR = 3.61, 95% CI 1.55 to 8.4, respectively). However, in patients with inferior MI this pattern only existed when ST resolution was incomplete (OR = 4.88, 95% CI 1.65 to 14.39, and OR = 4.34, 95% CI 1.66 to 11.37, respectively). CONCLUSION: These findings indicate that percentage ST resolution alone is an incomplete guide to 30-day and 1-year mortality. The integration of both the baseline and post-fibrinolysis ECG provides better risk assessment and can assist in the triage and treatment of such patients.
M Toma; Y Fu; G Wagner; S G Goodman; C Granger; L Wallentin; F Van de Werf; P Armstrong
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-10-11
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  94     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-15     Completed Date:  2008-04-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  e6     Citation Subset:  AIM; IM    
University of Alberta, Edmonton, Canada.
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MeSH Terms
Coronary Thrombosis / prevention & control
Electrocardiography / methods
Epidemiologic Methods
Fibrinolytic Agents / therapeutic use
Myocardial Infarction / diagnosis,  drug therapy,  mortality*,  physiopathology
Thrombolytic Therapy*
Reg. No./Substance:
0/Fibrinolytic Agents

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