Copyright © 1995 by the European Society of Cardiology.
© 1995 The European Society of Cardiology
Use of changes in ST segment elevation for prediction of infarct artery recanalization in acute myocardial infarction
Silesian Center of Cardiology Zabrze, Poland
revised 8 December 1994; accepted 21 December 1994.
Correspondence: Pawel Buszman, MD, Silesian Center of Cardiology, 2 Szpitalna Street, 41–800 Zabrze, Poland.
Abstract
Background: The role of the ECG in evaluating reperfusion status after thrombolytic treatment in acute myocardial infarction is not clear. Dramatic ST segment changes have been observed during recanalization of an infarct-related artery, but ST criteria have not been definitively established for prediction of coronary artery patency. Differences in ST segment changes in relation to infarct localization have not been evaluated, and further investigation is required into reciprocal ST depression, which provides information independent from ST elevation. Therefore, the aim of this study was to evaluate how early changes in ST segment elevations and depressions predict vessel patency after fibrinolysis for patients with anterior and inferiorllateral infarcts.
Methods and Results: Two hundred patients with a Pardee wave in the ECG and chest pain of less than 6 h duration were given thrombolytic treatment. The result of the therapy was assessed simultaneously with coronary angiography. Patients were divided into two groups: I (50 patients) without recanalization (TIMI grade 0, 1 or 2), and II (150 patients) with successful recanalization (TIMI grade 3). Before and after therapy, analysis of the 12 lead ECG included maximum ST elevation measurement (H1, H2 respectively), the sum of ST elevations (
H1, H2), the sum of ST segment depressions (h1, h2), and the ratios of ST segment changes (R1 = H2:H1, R2 = H2:H1, R3 = h2:h1). The mean interval from the first to the second ECG was 3.5 ± 1 h. Successive values of R1 and R2 were examined to find that which best distinguished between the two groups. The best values for prediction of reperfusion were:
(1) For anterior wall infarct
Specificity Sensitivity
R1 
0.6 83.3% 88.7%
R2 0.5 83.3% 92.0%
(2) For inferior and lateral infarct
R1 < 0.5 100% 93.8%
R2 < 0.5 100% 92.8%
In 13 patients with a complete right or left bundle branch block in the first or second ECG, the result of treatment was predicted in 11 patients using criteria for factor R1 and in 12 patients using criteria for R2
Analysis of ST segment depressions revealed a significant correlation between normalization of ST segment depressions and elevations (R3 vs R1: r = 0.60, P < 0.05; R3 vs R2 r = 0.59, P < 0.05). Multivariate discriminant analysis showed an independent value of R3for discrimination between the two groups, but only in patients with inferiorllateral infarcts. The overall accuracy of the common algorithm in predicting reperfusion was significantly better in patients with inferiorllateral infarcts (Chi2 test, P = 0.0078). When separate algorithms were used, there was no significant difference between patients with anterior or inferiorllateral infarcts because of the significant improvement in prediction of reperfusion in patients with anterior infarcts (McNemar's test: P = 0.041).
Conclusions: We conclude that analysis of ST segments on the standard 12-lead ECG offers valuable help in the early identification of successful recanalization of infarct-related arteries after thrombolytic therapy in patients with acute myocardial infarction. Use of the ratio of ST segment normalization according to the separate criteria for anterior and inferiorllateral infarcts gives the test a high sensitivity and specificity, even in the presence of interventricular conduction disturbances.
Key Words: ST segment analysis • infarct artery recanalization • fibrinolysis • acute myocardial infarction
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