European Heart Journal Advance Access originally published online on October 11, 2007
European Heart Journal 2007 28(24):2985-2991; doi:10.1093/eurheartj/ehm428
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The electrocardiographic window of opportunity to treat vs. the different evolving stages of ST-elevation myocardial infarction: correlation with therapeutic approach, coronary anatomy, and outcome in the DANAMI-2 trial
1 Department of Cardiology, Heart Center, Tampere University Hospital, Biokatu 6, PO Box 2000, 33520 Tampere, Finland
2 Department of Cardiology B, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
3 Procardia Medical Center, Tel Aviv, Israel
4 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
5 School of Public Health, University of Tampere, Tampere, Finland
Received 31 March 2007; revised 17 August 2007; accepted 31 August 2007; online publish-ahead-of-print 11 October 2007.
* Corresponding author. Tel: +358 3 311 66080; fax: +358 3 311 64157. E-mail address: markku.eskola{at}pshp.fi
See page 2957 for the editorial comment on this article (doi:10.1093/eurheartj/ehm512)
Aims: The aim of the study was to assess two distinct 12-lead electrocardiogram (ECG) patterns and their prognostic value with respect to reperfusion strategy.
Methods and results: In a DANAMI-2 substudy (n = 1522), we defined the pre-infarction syndrome (PIS) as ST-elevation accompanied by positive T waves and evolving myocardial infarction (EMI) as pathological Q waves and/or negative T wave. We used a composite of death, clinical re-infarction, or disabling stroke at median 2.7 year follow-up. A higher overall event rate was observed in the EMI group compared with the PIS group [11.4 (9.4–13.9) and 6.9 (6.0–8.0) per 100 person-years, respectively, ratio of the rate (RR) 1.6, P < 0.001]. The EMI pattern was independently predictive of adverse outcome in multivariable analysis (hazard ratio 1.52, confidence interval 1.01–2.30, P = 0.04). The PIS pattern (n = 952) was associated with lower overall event rate in patients treated with primary percutaneous coronary intervention (PCI) compared with fibrinolytic therapy (FT) [5.5 (4.4–6.9) and 8.5 (7.0–10.4) per 100 person-years, respectively, RR = 0.6, P = 0.004]. No significant difference in the outcome between treatment strategies was observed in the EMI group as a whole. However, in patients with anterior EMI without ECG signs of reperfusion, superiority of primary PCI was driven by a 51% reduction in the relative risk of composite endpoint (P = 0.008).
Conclusion: More detailed ECG analysis, involving also Q- and T-wave morphology, is useful for rapid identification of high-risk patients in whom every effort should be made to transfer for primary PCI, or vice versa, for identifying low-risk patients in whom FT might be an alternative option.
Key Words: Myocardial infarction • Electrocardiogram • Percutaneous coronary intervention • Fibrinolysis • Risk stratification • Prognosis
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- Use of the electrocardiogram in optimizing reperfusion for ST-elevation myocardial infarction: a new role for an old tool?
- Christos Kasapis and Brahmajee K. Nallamothu
EHJ 2007 28: 2957-2959.[Extract] [Full Text]
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  C. Kasapis and B. K. Nallamothu Use of the electrocardiogram in optimizing reperfusion for ST-elevation myocardial infarction: a new role for an old tool? Eur. Heart J., December 2, 2007; 28(24): 2957 - 2959. [Full Text] [PDF]
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