Early vectorcardiographic monitoring provides prognostic information in patients with ST-elevation myocardial infarction.
OBJECTIVE
To evaluate the prognostic value of specified vectorcardiographic data obtained during the first hours of ST-elevation myocardial infarction for cardiac outcomes up to 5 years.


METHODS
Three hundred and five patients with ST-elevation myocardial infarction and chest pain for less than 12 h were monitored with continuous vectorcardiography.


RESULTS
All patients had follow-up for at least 1 year. The mortality was 5.9% at 30 days and 10.8% at 1 year. The estimated 5-year mortality was 24%. A total of 7.9% had recurrent infarction at 30 days and 11.2% at 1 year. Recurrent infarction or death occurred in 12.1% at 30 days and in 19.7% at 1 year. The presence of ST-VM (plateau) >or= 125 microV was highly predictive of the combined endpoint death or recurrent infarction at 1 year, OR 2.69 (95% CI 1.39-5.23). Multivariate analysis showed that age >or=75 years, anterior myocardial infarction, and the presence of ST-VM (plateau) >or= 125 microV, were independently associated with increased risk of recurrent infarction or death at 1 year and with death at 5-year follow-up. A start value of ST-VM <or=100 microV identified a group of patients with low risk of death or re-infarction within 1 year.


CONCLUSIONS
Continuous vectorcardiography during the first hours after thrombolytic treatment of patients with ST-elevation myocardial infarction provides important prognostic information. A new vectorcardiographic variable, ST-VM (plateau), identifies a group of patients with increased risk of recurrent infarction or death. As well, patients with low risk of recurrent infarction or death were identified by low start values of ST-VM.
Jensen
S M
SM
Heart Centre, Division of Cardiology, University Hospital, Umeå, Sweden. steen.jensen@medicin.umu.se
Nilsson
J B
JB
Näslund
U
U
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003325:Coronary Care Units; D004562:Electrocardiography; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014672:Vectorcardiography