title: Continuously updated 12-lead ST-segment recovery analysis for myocardial infarct artery patency assessment and its correlation with multiple simultaneous early angiographic observations.
abstract: Early angiography may not adequately subgroup patients with myocardial infarction if cyclic changes in coronary flow occur frequently. From a pilot experience using a new 12-lead ST-segment monitor, a continuously updated, self-referenced ST-recovery analysis method was developed to quantify both instantaneous recovery, as a noninvasive marker of patency, and cumulative ST recovery over time, as a marker of the speed, stability and duration of reperfusion. In 22 patients with acute infarction in whom 44 observations of unique angiographic patency were noted within 6 hours of presentation, serial patency assessments simultaneous with all angiographic observations predicted coronary occlusion with 90% sensitivity and 92% specificity. Of the 22 patients, 11 (50%) had multiple ST trend transitions suggesting cyclic changes in coronary flow before catheterization. Speed, stability and duration of ST-segment recovery were defined by the time to first 50% ST recovery, total number of ST-trend transitions and patent physiology index (percentage of monitoring period showing ST recovery), respectively. Subgrouped angiographically, the median (interquartile range) for cumulative ST parameters with patent (n = 8) versus occluded (n = 14) arteries were, respectively--time to 50% recovery, 1.57 (1.16, 1.70) versus 0.17 (-0.47, 0.32) hours; number of reelevation/recovery events, 1.5 (1, 3) versus 3 (1, 3); and patent physiology index, 52 (47, 59) versus 50 (5, 73). Thus, continuous ST-segment recovery analysis appears to predict simultaneous angiographic patency over serial assessments, whereas cumulative parameters appear to contain independent information, probably because of patency changes before or after angiography.
authors.affiliation: Cardiology Division, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: M W
authors.initials: MW
authors.lastname: Krucoff
authors.forename: M A
authors.initials: MA
authors.lastname: Croll
authors.forename: J E
authors.initials: JE
authors.lastname: Pope
authors.forename: K S
authors.initials: KS
authors.lastname: Pieper
authors.forename: P M
authors.initials: PM
authors.lastname: Kanani
authors.forename: C B
authors.initials: CB
authors.lastname: Granger
authors.forename: R F
authors.initials: RF
authors.lastname: Veldkamp
authors.forename: B L
authors.initials: BL
authors.lastname: Wagner
authors.forename: S T
authors.initials: ST
authors.lastname: Sawchak
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010865:Pilot Projects; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors; D014654:Vascular Patency / Q000502:physiology