title: Ischemic ST-segment episodes during the initial 24 hours of ST elevation myocardial infarction predict prognosis at 1 and 5 years.
abstract: OBJECTIVE
  The aims of the study were to assess the prognostic value of recurrent ischemic episodes during the first 24 hours in ST elevation myocardial infarction (STEMI) treated with thrombolysis and to explore those episodes as a part of a low-risk prognostic feature.
  
  
  METHODS
  Two hundred twenty patients with STEMI treated with thrombolysis were monitored for 24 hours with continuous online vectorcardiography assessing ST vector changes to record recurrent ischemic events.
  
  
  RESULTS
  Ischemic events measured as an increase in ST-change vector magnitude (STC-VM) more than 50 muV for at least 2 minutes during 4- to 24-hour predicted mortality in a 5-year follow-up based on a multivariable analysis (hazard ratio, 1.18/episode; confidence interval, 1.01-1.37). The more episodes there were, the worse the prognosis. A low-risk group with a 1-year mortality of 1.9% could be identified.
  
  
  CONCLUSIONS
  Continuous ST-segment monitoring during the first 24 hours of a myocardial infarction is a valuable tool for identifying high- and low-risk patients. The STC-VM events during 4 to 24 hours of the first day of a myocardial infarction predict mortality within 5 years.
authors.affiliation: Department of Cardiology, Heart Centre, Umeå University Hospital, Umeå, Sweden. per.ottander@vll.se
authors.forename: Per
authors.initials: P
authors.lastname: Ottander
authors.forename: Johan B
authors.initials: JB
authors.lastname: Nilsson
authors.forename: Steen M
authors.initials: SM
authors.lastname: Jensen
authors.forename: Ulf
authors.initials: U
authors.lastname: Näslund
mesh_terms: D000368:Aged; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology