European Heart Journal Advance Access originally published online on October 14, 2005
European Heart Journal 2006 27(3):267-275; doi:10.1093/eurheartj/ehi606
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Potential significance of spontaneous and interventional ST-changes in patients transferred for primary percutaneous coronary intervention: observations from the ST-MONitoring in Acute Myocardial Infarction study (The MONAMI study)
1Department of Cardiology B, Skejby University Hospital, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark
2Department of Anaesthesiology, Skejby University Hospital, Aarhus, Denmark
3Department of Internal Medicine, Randers County Hospital, Randers, Denmark
4Department of Internal Medicine, Silkeborg County Hospital, Silkeborg, Denmark
Received 27 July 2005; revised 21 September 2005; accepted 29 September 2005; online publish-ahead-of-print 14 October 2005.
* Corresponding author. Tel: +45 89496234; fax: +45 89496009. E-mail address: christian_juhl_terkelsen{at}hotmail.com
See page 249 for the editorial comment on this article (doi:10.1093/eurheartj/ehi680)
Aims In patients with ST-elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively.
Methods and results In 92 STEMI patients, continuous ST-monitoring was initiated in the pre-hospital phase and continued during and 90 min following PCI. Patients were divided into three groups: (A) patients achieving spontaneous ST-resolution before PCI; (B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and (C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A (n=22), B (n=43), and C (n=27) differed in peak level of troponin-T (1.4, 4.7, and 7.2 µg/L, P<0.001), creatinine kinase MB isoenzyme (35, 150, and 325 µg/L, P<0.001), and N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) (183, 175, and 269 pmol/L, P=0.084) during admission, and left ventricular ejection fraction evaluated within 2 h of PCI (0.53, 0.48, and 0.45, P=0.047) and after 3 months (0.58, 0.54, and 0.45, P<0.001). Groups B and C also differed in time from first balloon inflation to 
70% resolution of ST-elevation (14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters.
Conclusion STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.
Key Words: Angioplasty • Continuous ST-monitoring • Electrocardiography • Myocardial infarction • Risk stratification • ST-resolution • Spontaneous ST-resolution
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