European Heart Journal Advance Access first published online on October 14, 2005
This version published online on December 8, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi606
1 Department of Cardiology B, Skejby University Hospital, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark
* To whom correspondence should be addressed. 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 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.
Received July 27, 2005
Revised September 21, 2005
Accepted September 29, 2005
Clinical research
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)
Christian Juhl Terkelsen 1 *,
Bjarne Linde Nørgaard 1,
Jens Flensted Lassen 1,
Steen Hvitfeldt Poulsen 1,
Jens Christian Gerdes 1,
Erik Sloth 2,
Liv Bjørn-Hansen Gøtzsche 3,
Frode Kirketerp Rømer 4,
Leif Thuesen 1,
Torsten Toftegaard Nielsen 1,
and
Henning Rud Andersen 1
2 Department of Anaesthesiology, Skejby University Hospital, Aarhus, Denmark
3 Department of Internal Medicine, Randers County Hospital, Randers, Denmark
4 Department of Internal Medicine, Silkeborg County Hospital, Silkeborg, Denmark
Christian Juhl Terkelsen, E-mail: christian_juhl_terkelsen{at}hotmail.com
Abstract 
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.
The originally published version of this paper was incorrect. The third line of the Conclusion should have read '...pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI ..'. The publisher apologizes that the error was not identified earlier.
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