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dc.contributor.authorVelury, Vijaya S.
dc.contributor.authorMa, Yunsheng
dc.contributor.authorHurley, Thomas G.
dc.contributor.authorHebert, James R.
dc.contributor.authorBecker, Clinton F.
dc.contributor.authorBecker, Richard C.
dc.date2022-08-11T08:10:20.000
dc.date.accessioned2022-08-23T17:05:07Z
dc.date.available2022-08-23T17:05:07Z
dc.date.issued1995-03-01
dc.date.submitted2008-01-15
dc.identifier.citationJ Thromb Thrombolysis. 1995;2(1):51-56.
dc.identifier.issn0929-5305 (Print)
dc.identifier.pmid10639213
dc.identifier.urihttp://hdl.handle.net/20.500.14038/44788
dc.description.abstractThe bedside surface 12-lead electrocardiogram is a mainstay in the early diagnostic evaluation of patients with suspected acute myocardial infarction. The presence of ST-segment elevation exceeding 1.0 mm in two or more anatomically associated leads is a reliable marker of myocardial injury and, when considered along with concomitant ST-segment depression, reflects the extent of myocardial injury. Mounting evidence also suggests that prolonged repolarization is a marker of injury and predicts the likelihood of malignant ventricular arrhythmias. We questioned whether a measure of both ST-segment duration and deviation (ST-deviation area) would offer additional prognostic information. Methods/Results: Admission electrocardiograms from 200 consecutive patients with ischemic chest pain accompanied by ST-segment elevation in whom thrombolytic therapy was given within 6 hours from symptom onset were analyzed. The sum of ST-segment elevation (Sigma ST elevation) and ST-segment deviation (Sigma ST deviation) were calculated, as was the sum of ST-segment deviation area (Sigma ST deviation area). All ST measurements were performed 60 msec after the J point. Computerized planimetry was used to calculate ST-segment area. Sigma ST deviation and Sigma ST deviation area remained constant over time. Patients with large deviations (Sigma ST elevation > 20 mm (odds ratio 2.14, p = 0.02) and Sigma ST deviation area > 150 (odds ratio 1.92, p = 0.02) had a higher incidence of in-hospital unsatisfactory clinical outcome (defined as death, congestive heart failure, cardiogenic shock, recurrent myocardial infarction, or the need for coronary revascularization). These relationships were present for both inferior and anterior infarctions. Sigma ST deviation area correlated closely with Sigma ST elevation (r = 0.92; p = 0.0001) and significantly but much less strongly with the sum of Q waves (r = 0.18; p = 0.01). By univariate analysis, only site of infarction (p = 0.01), Sigma ST deviation area (p = 0.04), and the sum of Q waves (p = 0.005) were identified as predictors of a poor clinical outcome. The sum of Q waves was identified by multivariate analysis as the best independent predictor of an unsatisfactory clinical outcome. Conclusions: A clinician's ability to provide optimal care is influenced strongly by the availability of diagnostic and prognostic information. In the evaluation of patients with acute myocardial infarction, ST-segment deviation area derived from the admission surface electrocardiogram can be used to risk-stratify patients. The full clinical potential of this measure is unknown and will require further evaluation.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10639213&dopt=Abstract ">Link to article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1007/BF01063162
dc.subjectElectrocardiography
dc.subjectMyocardial Infarction
dc.subjectThrombolytic Therapy
dc.subjectBehavioral Disciplines and Activities
dc.subjectBehavior and Behavior Mechanisms
dc.subjectCommunity Health and Preventive Medicine
dc.subjectPreventive Medicine
dc.titleClinical Utility of Electrocardiographic ST-Segment Area for Predicting Unsatisfactory Outcomes Following Thrombolytic Therapy
dc.typeJournal Article
dc.source.journaltitleJournal of Thombosis and Thrombolysis
dc.source.volume2
dc.source.issue1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/prevbeh_pp/21
dc.identifier.contextkey413357
html.description.abstract<p>The bedside surface 12-lead electrocardiogram is a mainstay in the early diagnostic evaluation of patients with suspected acute myocardial infarction. The presence of ST-segment elevation exceeding 1.0 mm in two or more anatomically associated leads is a reliable marker of myocardial injury and, when considered along with concomitant ST-segment depression, reflects the extent of myocardial injury. Mounting evidence also suggests that prolonged repolarization is a marker of injury and predicts the likelihood of malignant ventricular arrhythmias. We questioned whether a measure of both ST-segment duration and deviation (ST-deviation area) would offer additional prognostic information.</p> <p>Methods/Results: Admission electrocardiograms from 200 consecutive patients with ischemic chest pain accompanied by ST-segment elevation in whom thrombolytic therapy was given within 6 hours from symptom onset were analyzed. The sum of ST-segment elevation (Sigma ST elevation) and ST-segment deviation (Sigma ST deviation) were calculated, as was the sum of ST-segment deviation area (Sigma ST deviation area). All ST measurements were performed 60 msec after the J point. Computerized planimetry was used to calculate ST-segment area. Sigma ST deviation and Sigma ST deviation area remained constant over time. Patients with large deviations (Sigma ST elevation > 20 mm (odds ratio 2.14, p = 0.02) and Sigma ST deviation area > 150 (odds ratio 1.92, p = 0.02) had a higher incidence of in-hospital unsatisfactory clinical outcome (defined as death, congestive heart failure, cardiogenic shock, recurrent myocardial infarction, or the need for coronary revascularization). These relationships were present for both inferior and anterior infarctions. Sigma ST deviation area correlated closely with Sigma ST elevation (r = 0.92; p = 0.0001) and significantly but much less strongly with the sum of Q waves (r = 0.18; p = 0.01). By univariate analysis, only site of infarction (p = 0.01), Sigma ST deviation area (p = 0.04), and the sum of Q waves (p = 0.005) were identified as predictors of a poor clinical outcome. The sum of Q waves was identified by multivariate analysis as the best independent predictor of an unsatisfactory clinical outcome.</p> <p>Conclusions: A clinician's ability to provide optimal care is influenced strongly by the availability of diagnostic and prognostic information. In the evaluation of patients with acute myocardial infarction, ST-segment deviation area derived from the admission surface electrocardiogram can be used to risk-stratify patients. The full clinical potential of this measure is unknown and will require further evaluation.</p>
dc.identifier.submissionpathprevbeh_pp/21
dc.contributor.departmentDepartment of Medicine, Division of Preventive and Behavioral Medicine
dc.source.pages51-56


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