title: ST variability during the first 4 hours of acute myocardial infarction predicts 1-year mortality.
abstract: 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.
authors.affiliation: Clinical Experimental Research Laboratory, Sahlgrenska University, Hospital/Ostra, SE-416 85 Göteborg, Sweden. pj@hjl.gu.se
authors.forename: P
authors.initials: P
authors.lastname: Johanson
authors.forename: K
authors.initials: K
authors.lastname: Swedberg
authors.forename: M
authors.initials: M
authors.lastname: Dellborg
mesh_terms: 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*