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Prognostic implications of TIMI flow grade in the infarct related artery compared with continuous 12-lead ST-segment resolution analysis. Reexamining the "gold standard" for myocardial reperfusion assessment.

AbstractOBJECTIVE:
To compare the prognostic significance of reperfusion assessment by Thrombolysis in Myocardial Infarction (TIMI) flow grade in the infarct related artery and ST-segment resolution analysis, by correlating with clinical outcomes in patients with acute myocardial infarction (AMI).
BACKGROUND:
Angiographic assessment, based on epicardial coronary anatomy, has been considered the "gold standard" for reperfusion. The electrocardiogram (ECG) monitoring provides a noninvasive, real-time physiologic marker of cellular reperfusion and may better predict clinical outcomes.
METHODS:
Two hundred fifty-eight AMI patients from the Thrombolytics and Myocardia Infarction phase 7 and Global Utilization of Streptokinase tPA for Occluded coronary arteries phase 1 trials were stratified based on blinded, simultaneous reperfusion assessment on the acute angiogram (divided into TIMI grades 0 & 1, TIMI grade 2 and TIMI grade 3) and ST-segment resolution analysis (divided into: <50% ST-segment elevation resolution or reelevation and > or =50% ST-segment elevation resolution). In-hospital mortality, congestive heart failure (CHF) and combined mortality or CHF were compared to determine the prognostic significance of reperfusion assessment by each modality using chi-square and Fisher's Exact tests for univariable correlation and logistic regression analysis for univariable and multivariable prediction models.
RESULTS:
By logistic regression analysis, ST-segment resolution patterns were an independent predictor of the combined outcome of mortality or CHF (p = 0.024), whereas TIMI flow grade was not (p = 0.693). Among the patients determined to have failed reperfusion by TIMI flow grade assessment (TIMI flow grade 0 & 1), the ST-segment resolution of > or =50% identified a subgroup with relatively benign outcomes with the incidence of the combined end point of mortality or CHF 17.2% versus 37.2% in those without ST-segment resolution (p = 0.06).
CONCLUSION:
Continuous 12-lead ECG monitoring can be an inexpensive and reliable modality for monitoring nutritive reperfusion status and to obtain prognostic information in patients with AMI.
AuthorsA Shah, G S Wagner, C B Granger, C M O'Connor, C L Green, K M Trollinger, R M Califf, M W Krucoff
JournalJournal of the American College of Cardiology (J Am Coll Cardiol) Vol. 35 Issue 3 Pg. 666-72 (Mar 1 2000) ISSN: 0735-1097 [Print] UNITED STATES
PMID10716469 (Publication Type: Clinical Trial, Clinical Trial, Phase I, Comparative Study, Journal Article, Randomized Controlled Trial)
Chemical References
  • Streptokinase
  • Plasminogen Activators
Topics
  • Adult
  • Aged
  • Blood Flow Velocity
  • Coronary Angiography
  • Coronary Vessels (physiopathology)
  • Electrocardiography, Ambulatory
  • Humans
  • Middle Aged
  • Myocardial Infarction (mortality, physiopathology, therapy)
  • Plasminogen Activators (therapeutic use)
  • Prognosis
  • Reproducibility of Results
  • Streptokinase (therapeutic use)
  • Survival Rate
  • Thrombolytic Therapy

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