Prediction of 24 h, nonfatal complications in patients with acute myocardial infarction receiving thrombolytic therapy by calculation of the ST segment deviation score.
OBJECTIVE
To assess whether the sum of ST segment elevation and depression (ST segment deviation score [SUMSTdev]) is a better predictor for 24 h, nonfatal complications in patients with acute myocardial infarction (MI) than the sum of ST segment elevation (SUMSTelev) alone in the admission electrocardiogram.


METHODS
Patients with acute MI receiving thrombolytic therapy were observed and ST scores were evaluated. Nonfatal, 24 h complications were defined as acute congestive heart failure or severe rhythm disturbances within 24 h after the start of thrombolysis. The outcome measures were the relationship between both the SUMSTdev and the SUMSTelev and the occurence of 24 h complications, and the identification of a cut-off value with the highest sensitivity and specificity for the prediction of complications.


RESULTS
Three hundred eighty-two patients (288 male patients, mean age 58 years) with acute MI (179 patients with anterior MI) were included in the study. The SUMSTdev was significantly higher in patients with 24 h complications than in patients without complications (anterior MI 23.9 mm versus 11.5 mm, respectively, P<0.001; inferior MI 21.6 mm versus 12.0 mm, respectively, P<0.001). Using the receiver operating characteristic analysis, the SUMSTdev significantly improved the ability to estimate the occurence of 24 h complications for anterior and inferior MI compared with the SUMSTelev (anterior MI 0.87+/-0.03 versus 0.84+/-0.03, P=0.04; inferior MI 0.79+/-0.03 versus 0.74+/-0.04, P=0.03). The optimal cut-off for the SUMSTdev was found at 16 mm for anterior MI and 13 mm for inferior MI. Multivariate regression analysis showed that the SUMSTdev was an independent predictor of the occurrence of early complications in patients with anterior MI (odds ratio 28.4, 95% CI 11.0 to 73.6, P<0.0001) and inferior MI (odds ratio 9.7, 95% CI 4.7 to 20.2, P<0.001).


CONCLUSIONS
The SUMSTdev is superior to the SUMSTelev in predicting 24 h, nonfatal complications after acute MI. The use of the SUMSTdev is therefore recommended for the stratification of patients with acute MI into low and high risk patients.
Schreiber
Wolfgang
W
University Clinic of Emergency Medicine, Vienna, Austria.
Kittler
Harald
H
Pieper
Oliver
O
Woisetschlaeger
Christian
C
Laggner
Anton N
AN
Hirschl
Michael M
MM
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001241:Aspirin / Q000627:therapeutic use; D004562:Electrocardiography / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator; D001241:Aspirin