title: Changes in standard electrocardiographic ST-segment elevation predictive of successful reperfusion in acute myocardial infarction.
abstract: The ability of the electrocardiographic ST segment to predict successful reperfusion after thrombolytic therapy remains controversial. To evaluate whether angiographically determined reperfusion could be predicted from changes in ST-segment elevation, the sum of ST-segment elevation in affected leads of the electrocardiogram was compared before and after thrombolytic therapy in 53 patients with acute myocardial infarction (AMI). Reperfusion status of the infarct-related artery was determined angiographically less than 8 hours from onset of symptoms. According to the Thrombolysis in Myocardial Infarction trial (TIMI) criteria, 33 patients had successful reperfusion (TIMI grade 2 to 3 flow) after thrombolytic therapy and 20 patients did not (TIMI grade 0 to 1 flow). Logistic multiple regression analysis showed that the proportional value for the shift in the sum of ST elevation, termed the "% ST change," was more strongly associated with reperfusion than the absolute measured difference in millimeters (chi-square = 11.34 vs 9.22). The entire spectra of sensitivities and specificities were determined to identify a level of the percent ST change with simultaneous high sensitivity and specificity. A 20% decrease in ST elevation provided such a level (88% sensitivity, 80% specificity). The positive and negative predictive values of a 20% decrease in ST elevation were 88 and 80%, respectively. These results suggest that a decrease of only 20% in the sum of ST elevation in the standard electrocardiogram after thrombolytic therapy is a useful noninvasive predictor of reperfusion status in patients with evolving AMI.
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: P
authors.initials: P
authors.lastname: Clemmensen
authors.forename: E M
authors.initials: EM
authors.lastname: Ohman
authors.forename: D C
authors.initials: DC
authors.lastname: Sevilla
authors.forename: S
authors.initials: S
authors.lastname: Peck
authors.forename: N B
authors.initials: NB
authors.lastname: Wagner
authors.forename: P S
authors.initials: PS
authors.lastname: Quigley
authors.forename: P
authors.initials: P
authors.lastname: Grande
authors.forename: K L
authors.initials: KL
authors.lastname: Lee
authors.forename: G S
authors.initials: GS
authors.lastname: Wagner
mesh_terms: D006328:Cardiac Catheterization; D004562:Electrocardiography; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D015425:Myocardial Reperfusion; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator