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European Heart Journal Advance Access originally published online on April 11, 2005
European Heart Journal 2005 26(17):1726-1733; doi:10.1093/eurheartj/ehi221
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

A dynamic model forecasting myocardial infarct size before, during, and after reperfusion therapy: an ASSENT-2 ECG/VCG substudy

Per Johanson1,2,*, Yuling Fu3, Shaun G. Goodman4, Mikael Dellborg1, Paul W. Armstrong3, Mitchell W. Krucoff2, Lars Wallentin5 and Galen S. Wagner2

1Division of Cardiology, Sahlgrenska University Hospital/Östra, SE-41685 Göteborg, Sweden
2Duke University Medical Center, Durham, NC, USA
3University of Alberta, Edmonton, Canada
4Canadian Heart Research Center, and Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Canada
5Thoraxcenter, Akademiska Hospital, Uppsala, Sweden

Received 10 December 2003; revised 9 February 2005; accepted 17 February 2005; online publish-ahead-of-print 11 April 2005.

* Corresponding author. Tel: +46 31 343 4000; fax: +46 31 25 9254. E-mail address: pj{at}hjl.gu.se

This paper was guest edited by Prof. Bernard J. Gersh, Mayo Clinic, Rochester, USA

Aims Serial forecasts of final myocardial infarct (MI) size during fibrinolytic treatment (Rx) of ST-elevation MI would allow the identification of high-risk patients with a predicted major loss of viable myocardium, at a point when treatment may still be modified. We investigated a model for such forecasting, using time and the ECG.

Methods and results We collected 234 patients with ST-elevation MI, without signs of previous MI, bundle branch block, or hypertrophy. MI size was determined by the Selvester score and was ‘forecasted’ at: admission with patients stratified by delay time and an ECG acuteness score into three groups (EARLY, DISCORDANT, and LATE); 90 min after Rx by ≥70% ST-recovery or not and occurrence of "reperfusion peaks"; 4 h after Rx by ST re-elevations. EARLY patients had smaller final infarct sizes than LATE (9.4 vs. 20%, P=0.01). EARLY patients with ≥70% ST-recovery without a reperfusion peak had smaller infarct sizes than those with (3.1 vs. 12.5%, P=0.001). EARLY patients without ST re-elevations had smaller infarct sizes (1.5%) than those with some (9%) or many re-elevations (12%), P<0.001.

Conclusion Final infarct size can be forecasted using delay time and serial ECGs. Serially updated forecasts seem especially important when both clock-time and initial ECG- signs indicate earliness.

Key Words: Myocardial infarction • ECG • Infarct size • Fibrinolysis


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M. A. McDonald, Y. Fu, U. Zeymer, G. Wagner, S. G. Goodman, A. Ross, C. B. Granger, F. Van de Werf, P. W. Armstrong, and for the ASSENT-4 PCI Investigators
Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy
Eur. Heart J., April 1, 2008; 29(7): 871 - 879.
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