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Titolo:
ESTIMATES OF MYOCARDIUM AT RISK AND COLLATERAL FLOW IN ACUTE MYOCARDIAL-INFARCTION USING ELECTROCARDIOGRAPHIC INDEXES WITH COMPARISON TO RADIONUCLIDE AND ANGIOGRAPHIC MEASURES
Autore:
CHRISTIAN TF; GIBBONS RJ; CLEMENTS IP; BERGER PB; SELVESTER RH; WAGNER GS;
Indirizzi:
MAYO CLIN & MAYO FDN,DIV CARDIOVASC DIS & INTERNAL MED,200 1ST ST SW ROCHESTER MN 55905 LONG BEACH MEM HOSP MED CTR,DEPT MED LONG BEACH CA 00000 DUKE UNIV,MED CTR,DEPT MED DURHAM NC 27710
Titolo Testata:
Journal of the American College of Cardiology
fascicolo: 2, volume: 26, anno: 1995,
pagine: 388 - 393
SICI:
0735-1097(1995)26:2<388:EOMARA>2.0.ZU;2-Q
Fonte:
ISI
Lingua:
ENG
Soggetto:
LEFT-VENTRICULAR FUNCTION; ST-SEGMENT ELEVATION; TC-99M METHOXYISOBUTYL ISONITRILE; CORONARY-ARTERY OCCLUSION; QRS SCORING SYSTEM; REPERFUSION THERAPY; CONSCIOUS DOG; 12-LEAD ECG; SIZE; ANGIOPLASTY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
40
Recensione:
Indirizzi per estratti:
Citazione:
T.F. Christian et al., "ESTIMATES OF MYOCARDIUM AT RISK AND COLLATERAL FLOW IN ACUTE MYOCARDIAL-INFARCTION USING ELECTROCARDIOGRAPHIC INDEXES WITH COMPARISON TO RADIONUCLIDE AND ANGIOGRAPHIC MEASURES", Journal of the American College of Cardiology, 26(2), 1995, pp. 388-393

Abstract

Objectives. This study sought to determine the accuracy of the initial 12-lead electrocardiogram (ECG) in predicting final infarct size after direct coronary angioplasty for myocardial infarction and to examine which physiologic variables known to be determinants of outcome the ST segment changes most closely reflect. Background. Myocardium at risk, collateral flow and time to reperfusion have been shown to be independent physiologic predictors of infarct size in animal and clinical models. However, such measurements may be difficult to perform on a routine basis in patients with myocardial infarction. The standard 12-lead ECG is inexpensive and readily available. Methods. Sixty-seven patients with acute myocardial infarction, ST segment elevation and duration of chest pain <12 h had an initial injection of technetium-99m sestamibi. Tomographic imaging was performed 1 to 8 h later (after direct coronary angioplasty), and the images were quantified to measure perfusion defect size (myocardium at risk) and severity (a measure of collateral flow). Contrast agent injection and tomographic acquisition were repeated at hospital discharge to measure infarct size. The ST segmentelevation score was calculated for each patient according to infarct location and using previously described formulas. Results. ST segment elevation score correlated closest with the radionuclide measure of collateral flow (r = -0.44, p less than or equal to 0.0001), as well as an angiographic measure of collateral how (r = -0.38, p = 0.05). Although ST segment elevation score correlated weakly with the magnitude ofmyocardium at: risk by technetium-99m sestamibi, it was not as strongas infarct location alone in predicting myocardium at risk ([mean +/-SD] anterior 51 +/- 13% left ventricle vs. inferior 17 +/- 10% left ventricle, p < 0.0001). ST segment elevation score was weakly associated with final infarct size (r = 0.34, p = 0.005). A multivariate ECG model was constructed with infarct location as a surrogate for myocardium at risk, ST segment elevation score as a surrogate for estimated collateral flow, and elapsed time to reperfusion from onset of chest pain. All three variables were independently associated with infarct size. Conclusions. The initial standard 12-lead ECG can provide insight into myocardium at risk and, to a greater extent, collateral flow and canconsequently provide some estimate of subsequent infarct size. However, the confidence limits for such predictors are wide.

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Documento generato il 04/07/20 alle ore 17:58:32