BACKGROUND: Resolution of ST-segment elevation after thrombolysis for acute myocardial infarction has been shown to have prognostic significance 3 hours (180 minutes) after the initiation of therapy. Whether prognostically useful information can be achieved as early as 90 minutes after thrombolysis is unknown. METHODS: An electrocardiographic substudy of 2352 patients from the Global Use of Strategies To Open occluded coronary arteries (GUSTO-III) trial was undertaken to compare outcomes according to ST-segment resolution at 90 minutes versus 180 minutes after administration of thrombolytic therapy. RESULTS: Of 2352 patients in the substudy, 2241 had a baseline and 90-minute electrocardiogram, and 2218 had a baseline and 180-minute ECG. Complete ST-segment resolution occurred in 44.2% of patients at 90 minutes and 56.5% of patients at 180 minutes. ST-segment resolution at both 90 and 180 minutes was associated with lower 30-day and 1-year mortality. Multivariate analysis revealed ST-segment resolution at 90 minutes to be an equally strong predictor of 30-day mortality as resolution at 180 minutes. Patients who were at particularly high risk for mortality were those aged >70 years, those who presented with Killip class >1, and those with anterior infarctions. CONCLUSIONS: The presence of ST-segment resolution on standard 12-lead electrocardiographic monitoring 90 minutes after thrombolysis is a useful independent predictor of mortality at 30 days and 1 year. The potential for obtaining prognostic results as early as 90 minutes after thrombolysis sets a new precedent for optimum electrocardiographic monitoring times in these patients.
RCT Entities:
BACKGROUND: Resolution of ST-segment elevation after thrombolysis for acute myocardial infarction has been shown to have prognostic significance 3 hours (180 minutes) after the initiation of therapy. Whether prognostically useful information can be achieved as early as 90 minutes after thrombolysis is unknown. METHODS: An electrocardiographic substudy of 2352 patients from the Global Use of Strategies To Open occluded coronary arteries (GUSTO-III) trial was undertaken to compare outcomes according to ST-segment resolution at 90 minutes versus 180 minutes after administration of thrombolytic therapy. RESULTS: Of 2352 patients in the substudy, 2241 had a baseline and 90-minute electrocardiogram, and 2218 had a baseline and 180-minute ECG. Complete ST-segment resolution occurred in 44.2% of patients at 90 minutes and 56.5% of patients at 180 minutes. ST-segment resolution at both 90 and 180 minutes was associated with lower 30-day and 1-year mortality. Multivariate analysis revealed ST-segment resolution at 90 minutes to be an equally strong predictor of 30-day mortality as resolution at 180 minutes. Patients who were at particularly high risk for mortality were those aged >70 years, those who presented with Killip class >1, and those with anterior infarctions. CONCLUSIONS: The presence of ST-segment resolution on standard 12-lead electrocardiographic monitoring 90 minutes after thrombolysis is a useful independent predictor of mortality at 30 days and 1 year. The potential for obtaining prognostic results as early as 90 minutes after thrombolysis sets a new precedent for optimum electrocardiographic monitoring times in these patients.
Authors: Niels J Verouden; Joost D Haeck; Karel T Koch; José P Henriques; Jan Baan; René J van der Schaaf; Marije M Vis; Ron J Peters; Arthur A Wilde; Jan J Piek; Jan G Tijssen; Robbert J de Winter Journal: Ann Noninvasive Electrocardiol Date: 2010-04 Impact factor: 1.468
Authors: Matthew W Sherwood; David A Morrow; Benjamin M Scirica; Songtao Jiang; Christoph Bode; Nader Rifai; Robert E Gerszten; C Michael Gibson; Christopher P Cannon; Eugene Braunwald; Marc S Sabatine Journal: Am Heart J Date: 2010-06 Impact factor: 4.749
Authors: Cheuk-Kit Wong; Wanzhen Gao; Ralph A H Stewart; Jocelyne Benatar; John K French; Philip E G Aylward; Harvey D White Journal: Eur Heart J Date: 2010-05-31 Impact factor: 29.983
Authors: M B Faslur Rahuman; Jayanthimala B Jayawardena; George R Francis; Niraj Mahboob; Wasantha Kumara A H T; Aruna Wijesinghe; Rashan Haniffa; Ranithrie Ariyapperuma; Abbyramy Paramanayakam; Pubudu A De Silva Journal: Indian Heart J Date: 2017-03-06