title: Effect of thrombolytic therapy on the predictive value of signal-averaged electrocardiography after acute myocardial infarction.
abstract: Standard time domain variables from signal-averaged electrocardiography were examined in a population of 331 survivors of acute myocardial infarction. Of these subjects, 130 received early (less than 24 hours) thrombolytic therapy. During a follow-up of greater than or equal to 10 months, there were 17 arrhythmic events (8.5%) (sudden death or sustained symptomatic ventricular tachycardia) in the group without thrombolysis and 8 (6.2%) in those with thrombolysis. Statistically, highly significant differences between the signal-averaged electrocardiographic variables of patients with and without arrhythmic events were found in the group without thrombolysis, whereas only root-mean-square voltage of the terminal 40 ms of the signal-averaged QRS complex was statistically associated with outcome (the differences in the other 2 indexes being not significant) in patients with thrombolysis. When using 2 previously published categoric criteria for the diagnosis of abnormal signal-averaged electrocardiography, the performance of these criteria in predicting arrhythmic events was substantially better in the group without thrombolysis than in those with thrombolysis (positive predictive accuracy greater than 3 times lower). Retrospectively adjusted receiver-operator characteristics showed that for a sensitivity of 30%, the maximum achievable positive predictive accuracy of signal-averaged electrocardiography for arrhythmic events was 100% in the group without thrombolysis, but only 27% in those with thrombolysis. It is concluded that standard signal-averaged electrocardiography after acute myocardial infarction is less informative in patients who receive thrombolytic treatment.
authors.affiliation: Department of Cardiological Sciences, St. George's Hospital Medical School, London, England.
authors.forename: M
authors.initials: M
authors.lastname: Malik
authors.forename: P
authors.initials: P
authors.lastname: Kulakowski
authors.forename: O
authors.initials: O
authors.lastname: Odemuyiwa
authors.forename: J
authors.initials: J
authors.lastname: Poloniecki
authors.forename: A
authors.initials: A
authors.lastname: Staunton
authors.forename: T
authors.initials: T
authors.lastname: Millane
authors.forename: T
authors.initials: T
authors.lastname: Farrell
authors.forename: A J
authors.initials: AJ
authors.lastname: Camm
mesh_terms: D000328:Adult; D000368:Aged; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D013300:Streptokinase / Q000627:therapeutic use*; D015912:Thrombolytic Therapy
chemical_list: D013300:Streptokinase