ST variability during the first 4 hours of acute myocardial infarction predicts 1-year mortality.
BACKGROUND
Early and complete myocardial reperfusion is the goal when treating a patient with acute myocardial infarction. To achieve this in each individual, an on-line, accurate, easily handled and preferably noninvasive technique to monitor flow alterations is needed. Recurrent ST-segment elevation has been shown to reflect cyclic disturbances in perfusion.


METHODS
We have retrospectively analyzed ST variability in 102 patients with acute myocardial infarction randomized to 100 mg of rt-Pa or placebo. Patients were monitored for 24 hours using vectorcardiography.


RESULTS
Patients alive at one year (86%) had significantly less ST variability during the first four hours: 4.3 versus 7.1 episodes, P = 0.007. Patients having six or more ST episodes showed a 31.3% one-year mortality as compared to no mortality in patients having no ST variability. Furthermore ST variability was reduced by fibrinolysis.


CONCLUSIONS
Early ST variability detectable in real time is associated with worse outcome.
Johanson
P
P
Clinical Experimental Research Laboratory, Sahlgrenska University, Hospital/Ostra, SE-416 85 Göteborg, Sweden. pj@hjl.gu.se
Swedberg
K
K
Dellborg
M
M
D000465:Algorithms; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D014672:Vectorcardiography / Q000401:mortality*