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Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty

Billgren, Therese LU ; Maynard, C; Christian, TF; Rahman, MA; Saeed, M; Hammill, SC; Wagner, GS and Birnbaum, Y (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)
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author
organization
publishing date
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
2007-08-14 08:39:44
date last changed
2017-05-28 03:38:44
@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},
  keyword      = {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},
  volume       = {38},
  year         = {2005},
}