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Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion.

Publication ,  Journal Article
Krucoff, MW; Croll, MA; Pope, JE; Granger, CB; O'Connor, CM; Sigmon, KN; Wagner, BL; Ryan, JA; Lee, KL; Kereiakes, DJ
Published in: Circulation
August 1993

BACKGROUND: If a practical, reliable, noninvasive marker of failed reperfusion was available in real time, the benefits of further therapy in this patient subgroup could be tested. We developed a method of 12-lead ST-segment recovery analysis using continuously updated reference points to provide such a marker. METHODS AND RESULTS: In this study, our method was prospectively tested in 144 patients given thrombolytic therapy early in myocardial infarction. All patients had 12-lead continuous ST-segment monitoring and acute angiography, each analyzed in an independent, blinded core laboratory. ST-segment recovery and re-elevation were analyzed up to the moment of angiography, at which time patency was predicted. Predictions were correlated to angiographic infarct artery flow, with TIMI flow 0 to 1 as occluded and TIMI flow 2 to 3 as patent. Infarct artery occlusion was seen on first injection in 27% of patients. The positive predictive value of incomplete ST recovery or ST re-elevation by our method was 71%, negative predictive value 87%, with 90% specificity and 64% sensitivity for coronary occlusion. ST recovery analysis predicted patency in 94% of patients with TIMI 3 flow versus 81% of patients with TIMI 2 flow and predicted occlusion in 57% of patients with collateralized occlusion versus 72% of patients with non-collateralized occlusion. In a regression model including other noninvasive clinical descriptors, ST recovery alone contained the vast majority of predictive information about patency. CONCLUSIONS: In a blinded, prospective, angiographically correlated study design, 12-lead continuous ST-segment recovery analysis shows promise as a practical noninvasive marker of failed reperfusion that may contribute substantially to currently available bedside assessment. Our data also suggest that patients with TIMI 2 flow or with collateralized occlusions may represent a physiological spectrum definable with ST-segment recovery analysis.

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Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

August 1993

Volume

88

Issue

2

Start / End Page

437 / 446

Location

United States

Related Subject Headings

  • Treatment Failure
  • Prospective Studies
  • Predictive Value of Tests
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Electrocardiography
 

Citation

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Krucoff, M. W., Croll, M. A., Pope, J. E., Granger, C. B., O’Connor, C. M., Sigmon, K. N., … Kereiakes, D. J. (1993). Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion. Circulation, 88(2), 437–446. https://doi.org/10.1161/01.cir.88.2.437
Krucoff, M. W., M. A. Croll, J. E. Pope, C. B. Granger, C. M. O’Connor, K. N. Sigmon, B. L. Wagner, J. A. Ryan, K. L. Lee, and D. J. Kereiakes. “Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion.Circulation 88, no. 2 (August 1993): 437–46. https://doi.org/10.1161/01.cir.88.2.437.
Krucoff MW, Croll MA, Pope JE, Granger CB, O’Connor CM, Sigmon KN, et al. Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion. Circulation. 1993 Aug;88(2):437–46.
Krucoff, M. W., et al. “Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion.Circulation, vol. 88, no. 2, Aug. 1993, pp. 437–46. Pubmed, doi:10.1161/01.cir.88.2.437.
Krucoff MW, Croll MA, Pope JE, Granger CB, O’Connor CM, Sigmon KN, Wagner BL, Ryan JA, Lee KL, Kereiakes DJ. Continuous 12-lead ST-segment recovery analysis in the TAMI 7 study. Performance of a noninvasive method for real-time detection of failed myocardial reperfusion. Circulation. 1993 Aug;88(2):437–446.

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

August 1993

Volume

88

Issue

2

Start / End Page

437 / 446

Location

United States

Related Subject Headings

  • Treatment Failure
  • Prospective Studies
  • Predictive Value of Tests
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Electrocardiography