Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty
(2005) In Journal of Electrocardiology 38(3). p.187-194- Abstract
- Background: Among patients with ST-elevation acute myocardial infarction, those with terminal QRS distortion (grade 3 ischemia) have higher mortality and larger infarct size (IS) than patients without QRS distortion (grade 2 ischemia). Methods: We assessed the relation of baseline electrocardiographic ischemia grades to area at risk (AR) and myocardial salvage [100 (AR - IS)/AR] in 79 patients who underwent primary angioplasty for first ST-elevation acute myocardial infarction and had technetium Tc 99m sestamibi single-photon emission computed tomography before angioplasty (AR) and at predischarge (IS). Patients were classified as having grade 2 ischemia (ST elevation without terminal QRS distortion in any of the leads, n = 48), grade 2.5... (More)
- Background: Among patients with ST-elevation acute myocardial infarction, those with terminal QRS distortion (grade 3 ischemia) have higher mortality and larger infarct size (IS) than patients without QRS distortion (grade 2 ischemia). Methods: We assessed the relation of baseline electrocardiographic ischemia grades to area at risk (AR) and myocardial salvage [100 (AR - IS)/AR] in 79 patients who underwent primary angioplasty for first ST-elevation acute myocardial infarction and had technetium Tc 99m sestamibi single-photon emission computed tomography before angioplasty (AR) and at predischarge (IS). Patients were classified as having grade 2 ischemia (ST elevation without terminal QRS distortion in any of the leads, n = 48), grade 2.5 ischemia (ST elevation with terminal QRS distortion in 1 lead, n = 16), or grade 3 ischemia (ST elevation with terminal QRS distortion in > 2 adjacent leads, n = 15). Results: Time to treatment was comparable among groups. AR was comparable among groups (38% +/- 20%, 33% +/- 23%, and 34% +/- 23%, respectively; P = .70). There were no differences among groups in residual myocardial perfusion (severity index 0.28 +/- 0.12, 0.29 +/- 0.16, and 0.30 +/- 0.15 in grades 2, 2.5, and 3 ischemia, respectively; P = .97). In contrast, there was a trend toward lower myocardial salvage (45% +/- 32%) in the grade 3 group than in the grade 2 (65% +/- 33%) and grade 2.5 (65% +/- 40%) groups (P = .16). Salvage was dependent on time only in the grade 3 group. Spearman rank correlation coefficients between time to treatment and percentage salvage were 0.003 (P = .99), -0.24 (P = .38), and -0.63 (P = .022) for grades 2, 2.5, and 3, respectively. Conclusions: Patients with grade 3 ischemia have rapid progression of necrosis over time and less myocardial salvage. This admission pattern is a predictor of myocardial salvage by primary angioplasty. (Less)
Please use this url to cite or link to this publication:
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- author
- Billgren, Therese LU ; Maynard, C ; Christian, TF ; Rahman, MA ; Saeed, M ; Hammill, SC ; Wagner, GS and Birnbaum, Y
- organization
- publishing date
- 2005
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- infarct size, acute myocardial infarction, electrocardiography, risk, area at
- in
- Journal of Electrocardiology
- volume
- 38
- issue
- 3
- pages
- 187 - 194
- publisher
- Elsevier
- external identifiers
-
- wos:000230775000004
- pmid:16003698
- scopus:21244439912
- ISSN
- 1532-8430
- DOI
- 10.1016/j.jelectrocard.2005.03.010
- language
- English
- LU publication?
- yes
- id
- 7260fc5d-fd84-4adc-a836-1afda6cba21d (old id 232024)
- date added to LUP
- 2016-04-01 12:01:11
- date last changed
- 2022-01-26 21:39:33
@article{7260fc5d-fd84-4adc-a836-1afda6cba21d,
abstract = {{Background: Among patients with ST-elevation acute myocardial infarction, those with terminal QRS distortion (grade 3 ischemia) have higher mortality and larger infarct size (IS) than patients without QRS distortion (grade 2 ischemia). Methods: We assessed the relation of baseline electrocardiographic ischemia grades to area at risk (AR) and myocardial salvage [100 (AR - IS)/AR] in 79 patients who underwent primary angioplasty for first ST-elevation acute myocardial infarction and had technetium Tc 99m sestamibi single-photon emission computed tomography before angioplasty (AR) and at predischarge (IS). Patients were classified as having grade 2 ischemia (ST elevation without terminal QRS distortion in any of the leads, n = 48), grade 2.5 ischemia (ST elevation with terminal QRS distortion in 1 lead, n = 16), or grade 3 ischemia (ST elevation with terminal QRS distortion in > 2 adjacent leads, n = 15). Results: Time to treatment was comparable among groups. AR was comparable among groups (38% +/- 20%, 33% +/- 23%, and 34% +/- 23%, respectively; P = .70). There were no differences among groups in residual myocardial perfusion (severity index 0.28 +/- 0.12, 0.29 +/- 0.16, and 0.30 +/- 0.15 in grades 2, 2.5, and 3 ischemia, respectively; P = .97). In contrast, there was a trend toward lower myocardial salvage (45% +/- 32%) in the grade 3 group than in the grade 2 (65% +/- 33%) and grade 2.5 (65% +/- 40%) groups (P = .16). Salvage was dependent on time only in the grade 3 group. Spearman rank correlation coefficients between time to treatment and percentage salvage were 0.003 (P = .99), -0.24 (P = .38), and -0.63 (P = .022) for grades 2, 2.5, and 3, respectively. Conclusions: Patients with grade 3 ischemia have rapid progression of necrosis over time and less myocardial salvage. This admission pattern is a predictor of myocardial salvage by primary angioplasty.}},
author = {{Billgren, Therese and Maynard, C and Christian, TF and Rahman, MA and Saeed, M and Hammill, SC and Wagner, GS and Birnbaum, Y}},
issn = {{1532-8430}},
keywords = {{infarct size; acute myocardial infarction; electrocardiography; risk; area at}},
language = {{eng}},
number = {{3}},
pages = {{187--194}},
publisher = {{Elsevier}},
series = {{Journal of Electrocardiology}},
title = {{Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty}},
url = {{http://dx.doi.org/10.1016/j.jelectrocard.2005.03.010}},
doi = {{10.1016/j.jelectrocard.2005.03.010}},
volume = {{38}},
year = {{2005}},
}