ST-segment depression on ambulatory electrocardiography in the early in-hospital period after acute myocardial infarction predicts early and late mortality: a short-term and a 3-year follow-up study.
A surveillance study was conducted to determine the in-hospital and long-term prognostic value of ST-segment depression assessed by ambulatory electrocardiographic monitoring (AEM) during the early in-hospital period after acute myocardial infarction (AMI). ST-segment depression (STD) was determined by computer analysis of 24-h ECG tapes as a horizontal or downsloping change in ST level by > 0.1 mV from the reference base line. The ST level was measured 80 ms after the J point of all normally conducted complexes for > or = 1 min. All computer-detected ST events were verified by one trained reader. Tapes corresponding to 74 patients were analyzed. In addition, 23 tapes corresponding to age- and gender-matched controls were also analyzed. Patients were divided into two groups: 22 patients (30%) showed STD (Group A), and 52 patients (70%) had no episode of STD (Group B). Among controls, 1 person (4%) showed STD. During the early follow-up period (14 +/- 11 days after hospital admission), cardiac events occurred in 11 patients [7 (32%) in Group A and 4(8%) in Group B, p < 0.01], including 6 cardiac death [5 (23%) in Group A and 1 (2%) in Group B, p < 0.01], 3 acute coronary artery bypass surgeries [2 (9%) in Group A and 1 (2%) in Group B, p = NS], and 2 nonfatal myocardial infractions (both in Group A, p = NS). During a mean follow-up period of 3 years (36 +/- 15 months), 18 patients died [10 (45%) in Group A and 8 (15%) in Group B, p = 0.01]. Eleven deaths were sudden [7 (32%) in Group A and 4 (8%) in Group B, p < 0.01]. Eighteen AMI occurred [11 (50%) in Group A and 7 (13%) in Group B, p < 0.005]. Twenty patients underwent revascularization procedures [7 (32%) in Group A and 13 (25%) in Group B, p = NS].(ABSTRACT TRUNCATED AT 250 WORDS)
Quintana
M
M
Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden.
Lindvall
K
K
Carlens
P
P
Bevegård
S
S
Brolund
F
F
D003936:Diagnosis, Computer-Assisted; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies