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Prognostic significance of ST segment shift early after resolution of ST elevation in patients with myocardial infarction treated with thrombolytic therapy: the GUSTO-I ST Segment Monitoring Substudy.

Publication ,  Journal Article
Langer, A; Krucoff, MW; Klootwijk, P; Simoons, ML; Granger, CB; Barr, A; Califf, RM; Armstrong, PW
Published in: J Am Coll Cardiol
March 15, 1998

OBJECTIVES: We sought to study the relation between recurrent ST segment shift within 6 to 24 h of initial resolution of ST elevation after thrombolytic therapy and 30-day and 1-year mortality. BACKGROUND: Rapid and stable resolution of ST segment elevation in relation to thrombolytic therapy in patients with an acute myocardial infarction is an indicator of culprit artery patency. Whether recurrence of ST segment shift during continuous ST monitoring after initial resolution is related to poor prognosis has not been studied. METHODS: ST segment monitoring was performed within 30 min after thrombolytic therapy for acute myocardial infarction. The predictive value of a new ST segment shift (assessed as > or = 0.1-mV deviation from the baseline) 6 to 24 h after thrombolytic therapy was studied with respect to 30-day and 1-year mortality. RESULTS: Of 734 patients, 243 had a new ST segment shift (33%). The 30-day mortality rate in patients with an ST shift (7.8%) was significantly higher than that in patients without an ST shift (2.25%, p = 0.001), as was the 1-year mortality rate (10.3% vs. 5.7%, respectively, p = 0.025). Multivariable analysis revealed an independent predictive value of ST shift with respect to 30-day mortality (p = 0.008), even after consideration of multiple clinical risk factors in the overall Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO)-I mortality model (p = 0.0001). Moreover, the duration of the ST shift bore a direct relation with 1-year mortality (p = 0.008). CONCLUSIONS: Detection of ST segment shift early after thrombolytic therapy for acute myocardial infarction is a simple, noninvasive means of identifying patients at high risk and is superior to other commonly assessed clinical risk factors. Thus, patients with a new ST shift after the first 6 h, but within 24 h, represent a high risk group that may benefit from more aggressive intervention, whereas patients without evidence of an ST shift represent a low risk subgroup.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 15, 1998

Volume

31

Issue

4

Start / End Page

783 / 789

Location

United States

Related Subject Headings

  • Tissue Plasminogen Activator
  • Time Factors
  • Thrombolytic Therapy
  • Survival Rate
  • Streptokinase
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Myocardial Infarction
  • Middle Aged
 

Citation

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Langer, A., Krucoff, M. W., Klootwijk, P., Simoons, M. L., Granger, C. B., Barr, A., … Armstrong, P. W. (1998). Prognostic significance of ST segment shift early after resolution of ST elevation in patients with myocardial infarction treated with thrombolytic therapy: the GUSTO-I ST Segment Monitoring Substudy. J Am Coll Cardiol, 31(4), 783–789. https://doi.org/10.1016/s0735-1097(97)00544-5
Langer, A., M. W. Krucoff, P. Klootwijk, M. L. Simoons, C. B. Granger, A. Barr, R. M. Califf, and P. W. Armstrong. “Prognostic significance of ST segment shift early after resolution of ST elevation in patients with myocardial infarction treated with thrombolytic therapy: the GUSTO-I ST Segment Monitoring Substudy.J Am Coll Cardiol 31, no. 4 (March 15, 1998): 783–89. https://doi.org/10.1016/s0735-1097(97)00544-5.
Langer A, Krucoff MW, Klootwijk P, Simoons ML, Granger CB, Barr A, Califf RM, Armstrong PW. Prognostic significance of ST segment shift early after resolution of ST elevation in patients with myocardial infarction treated with thrombolytic therapy: the GUSTO-I ST Segment Monitoring Substudy. J Am Coll Cardiol. 1998 Mar 15;31(4):783–789.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 15, 1998

Volume

31

Issue

4

Start / End Page

783 / 789

Location

United States

Related Subject Headings

  • Tissue Plasminogen Activator
  • Time Factors
  • Thrombolytic Therapy
  • Survival Rate
  • Streptokinase
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Prognosis
  • Myocardial Infarction
  • Middle Aged