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European Heart Journal 1992 13(12):1619-1625;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

ST segment analysis for assessment of coronary artery patency: comparison of surface ECG and Holter recordings

M. ZABEL, S. H. HOHNLOSER, A. PARUSSEL and H. JUST

University of Freiburg, Department of Cardiology Freiburg, Germany

Received 17 March 1992; revised 8 July 1992; .

Correspondence Stefan H. Hohnloser, MD, F.A.C.C., University Hospital Freiburg, Dep of Cardiology, Hugstetter Str. 55, 7800 Freiburg, Germany

Abstract

In a prospective trial in 124 patients with acute myocardial infarction, Holter and surface ECG recordings were obtained simultaneously and compared for their ability to assess thrombolysis-induced ST segment changes. Accuracy in predicting patency of the infarct-related artery was evaluated in both methods. Success or failure of thrombolysis was determined angiographically 90 min after the start of therapy. For both methods, sensitivity, specificity, and positive predictive value for correct prediction of the perfusion status ranged between 64% and 92%. However, the negative predictive value was considerably lower (40–53%). There were no significant differences in any parameter evaluated for either method. Thus, two surface ECG recordings before and 2 h after the start of therapy yield the same predictive value as continuous Holter monitoring with respect to thromboly sis-induced coronary artery reperfusion. However, for triage of patients to early coronary interventions, more sophisticated methods are needed for non-invasive prediction of coronary artery patency due to the low negative predictive value of ST segment analysis.

Key Words: Thrombolysis • infarction • acute myocardial • ST-segment analysis • Holter ECG


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