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European Heart Journal Advance Access published online on April 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi221
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received December 10, 2003
Revised February 9, 2005
Accepted February 17, 2005

Clinical research

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

Per Johanson 1*, Yuling Fu 2, Shaun G. Goodman 3, Mikael Dellborg 4, Paul W. Armstrong 2, Mitchell W. Krucoff 5, Lars Wallentin 6, and Galen S. Wagner 5

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

* To whom correspondence should be addressed.
Per Johanson, E-mail: pj{at}hjl.gu.se


  Abstract

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.

Keywords: 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.
[Abstract] [Full Text] [PDF]


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