title: Vectorcardiographic monitoring to assess early vessel patency after reperfusion therapy for acute myocardial infarction.
abstract: Reperfusion therapy has lowered mortality in patients suffering from acute myocardial infarction. Failure to reperfuse is associated with an increased short- and long-term mortality. In a prospective study we used dynamic vectorcardiography to monitor 96 patients with acute myocardial infarction treated with reperfusion therapy to non-invasively assess coronary patency. The results from continuous monitoring were compared to those obtained from angiography. By using trend-analysis of QRS vector difference and ST vector magnitude, we were able to correctly identify 58 of the 70 patients (83%) with a reperfused infarct-related artery, and 19 of the 26 patients (73%) with a persistently occluded artery demonstrated at an early angiogram (diagnostic accuracy 80%). In patients with high-grade collateral flow to the infarct-related area, the results of the vectorcardiographic monitoring and of angiography showed the largest disagreement, whereas the accuracy of vectorcardiographic monitoring was high: 88% among patients without collaterals. The present results suggest that QRS complex and ST segment vectorcardiographic monitoring is a useful tool for assessing early coronary artery patency, and that dynamic vectorcardiography may help in identifying candidates for emergency coronary angiography.
authors.affiliation: Department of Medicine, Ostra Hospital, Göteborg University, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Dellborg
authors.forename: P G
authors.initials: PG
authors.lastname: Steg
authors.forename: M
authors.initials: M
authors.lastname: Simoons
authors.forename: R
authors.initials: R
authors.lastname: Dietz
authors.forename: S
authors.initials: S
authors.lastname: Sen
authors.forename: M
authors.initials: M
authors.lastname: van den Brand
authors.forename: U
authors.initials: U
authors.lastname: Lotze
authors.forename: S
authors.initials: S
authors.lastname: Hauck
authors.forename: R
authors.initials: R
authors.lastname: van den Wieken
authors.forename: D
authors.initials: D
authors.lastname: Himbert
mesh_terms: D000208:Acute Disease; D003097:Collateral Circulation; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D015425:Myocardial Reperfusion; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014654:Vascular Patency; D014672:Vectorcardiography