Change in ST segment elevation 60 minutes after thrombolytic initiation predicts clinical outcome as accurately as later electrocardiographic changes.
OBJECTIVE
To compare prospectively the prognostic accuracy of a 50% decrease in ST segment elevation on standard 12-lead electrocardiograms (ECGs) recorded at 60, 90, and 180 minutes after thrombolysis initiation in acute myocardial infarction.


METHODS
Consecutive sample prospective cohort study.


METHODS
A single coronary care unit in the north of England.


METHODS
190 consecutive patients receiving thrombolysis for first acute myocardial infarction.


METHODS
Thrombolysis at baseline.


METHODS
Cardiac mortality and left ventricular size and function assessed 36 days later.


RESULTS
Failure of ST segment elevation to resolve by 50% in the single lead of maximum ST elevation or the sum ST elevation of all infarct related ECG leads at each of the times studied was associated with a significantly higher mortality, larger left ventricular volume, and lower ejection fraction. There was some variation according to infarct site with only the 60 minute ECG predicting mortality after inferior myocardial infarction and only in anterior myocardial infarction was persistent ST elevation associated with worse left ventricular function. The analysis of the lead of maximum ST elevation at 60 minutes from thrombolysis performed as well as later ECGs in receiver operating characteristic curves for predicting clinical outcome.


CONCLUSIONS
The standard 12-lead ECG at 60 minutes predicts clinical outcome as accurately as later ECGs after thrombolysis for first acute myocardial infarction.
Purcell
I F
IF
Department of Cardiology, Sunderland District General Hospital, UK.
Newall
N
N
Farrer
M
M
D000368:Aged; D003325:Coronary Care Units; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome