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. 1997 Jun;77(6):506–511. doi: 10.1136/hrt.77.6.506

Significance of initial ST segment changes for thrombolytic treatment in first inferior myocardial infarction.

K Schröder 1, K Wegscheider 1, K L Neuhaus 1, U Tebbe 1, R Schröder 1
PMCID: PMC484791  PMID: 9227292

Abstract

OBJECTIVE: To evaluate the benefit to risk ratio of thrombolytic treatment in patients with small inferior acute myocardial infarction (AMI). Controlled studies relating the benefit from thrombolysis with initial electrocardiographic features are scarce and of limited sample size. DESIGN: Retrospective study of 728 patients with a first inferior AMI of six hours' duration from the Intravenous Streptokinase in Acute Myocardial Infarction (ISAM) study comparing streptokinase with placebo stratified by the initial sum ST segment elevation (sigma ST) of 0.8 mV or less and greater than 0.8 mV, and 636 patients from the International Joint Efficacy Comparison of Thrombolytics (INJECT) trial comparing double blind streptokinase with reteplase stratified by either sigma ST or the presence of precordial ST segment depression. RESULTS: ISAM study patients with an sigma ST of greater than 0.8 mV had a significant mortality benefit from streptokinase throughout six years, while those with an sigma ST of 0.8 mV or less showed a trend to higher mortality at six months (6.3% streptokinase v 5.1% placebo). Despite significantly smaller infarcts and fewer clinical complications in patients with an sigma ST of 0.8 mV or less (ISAM and INJECT) or the absence of precordial ST segment depression (INJECT) thrombolytic treatment was associated with higher early mortality than in those with initially larger ST segment deviations. CONCLUSION: Thrombolytic treatment in patients with inferior AMI presenting with larger ST segment deviations is associated with improved survival throughout six years. The risk to benefit ratio, however, in terms of early mortality in patients who have an sigma ST of 0.8 mV or less and no precordial ST segment depression may be unfavourable.

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Selected References

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  1. Aldrich H. R., Wagner N. B., Boswick J., Corsa A. T., Jones M. G., Grande P., Lee K. L., Wagner G. S. Use of initial ST-segment deviation for prediction of final electrocardiographic size of acute myocardial infarcts. Am J Cardiol. 1988 Apr 1;61(10):749–753. doi: 10.1016/0002-9149(88)91060-0. [DOI] [PubMed] [Google Scholar]
  2. Bar F. W., Vermeer F., de Zwaan C., Ramentol M., Braat S., Simoons M. L., Hermens W. T., van der Laarse A., Verheugt F. W., Krauss X. H. Value of admission electrocardiogram in predicting outcome of thrombolytic therapy in acute myocardial infarction. A randomized trial conducted by The Netherlands Interuniversity Cardiology Institute. Am J Cardiol. 1987 Jan 1;59(1):6–13. doi: 10.1016/s0002-9149(87)80060-7. [DOI] [PubMed] [Google Scholar]
  3. Bates E. R., Clemmensen P. M., Califf R. M., Gorman L. E., Aronson L. G., George B. S., Kereiakes D. J., Topol E. J. Precordial ST segment depression predicts a worse prognosis in inferior infarction despite reperfusion therapy. The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group. J Am Coll Cardiol. 1990 Dec;16(7):1538–1544. doi: 10.1016/0735-1097(90)90297-3. [DOI] [PubMed] [Google Scholar]
  4. Hlatky M. A., Califf R. M., Lee K. L., Pryor D. B., Wagner G. S., Rosati R. A. Prognostic significance of precordial ST-segment depression during inferior acute myocardial infarction. Am J Cardiol. 1985 Feb 1;55(4):325–329. doi: 10.1016/0002-9149(85)90369-8. [DOI] [PubMed] [Google Scholar]
  5. Kennedy J. W., Atkins J. M., Goldstein S., Jaffe A. S., Lambrew C. T., McIntyre K. M., Mueller H. S., Paraskos J. A., Weaver W. D. Recent changes in management of acute myocardial infarction: implications for emergency care physicians. J Am Coll Cardiol. 1988 Feb;11(2):446–449. doi: 10.1016/0735-1097(88)90114-3. [DOI] [PubMed] [Google Scholar]
  6. Lew A. S., Maddahi J., Shah P. K., Weiss A. T., Peter T., Berman D. S., Ganz W. Factors that determine the direction and magnitude of precordial ST-segment deviations during inferior wall acute myocardial infarction. Am J Cardiol. 1985 Apr 1;55(8):883–888. doi: 10.1016/0002-9149(85)90711-8. [DOI] [PubMed] [Google Scholar]
  7. Mauri F., Gasparini M., Barbonaglia L., Santoro E., Grazia Franzosi M., Tognoni G., Rovelli F. Prognostic significance of the extent of myocardial injury in acute myocardial infarction treated by streptokinase (the GISSI trial). Am J Cardiol. 1989 Jun 1;63(18):1291–1295. doi: 10.1016/0002-9149(89)91037-0. [DOI] [PubMed] [Google Scholar]
  8. Mirvis D. M. Physiologic bases for anterior ST segment depression in patients with acute inferior wall myocardial infarction. Am Heart J. 1988 Nov;116(5 Pt 1):1308–1322. doi: 10.1016/0002-8703(88)90456-5. [DOI] [PubMed] [Google Scholar]
  9. Muller J. E., Maroko P. R., Braunwald E. Precordial electrocardiographic mapping. A technique to assess the efficacy of interventions designed to limit infarct size. Circulation. 1978 Jan;57(1):1–18. doi: 10.1161/01.cir.57.1.1. [DOI] [PubMed] [Google Scholar]
  10. Schröder R., Linderer T., Brüggemann T., Neuhaus K. L., Tebbe U., Wegscheider K. Controversial indications. Rationale for thrombolysis: later than 4-6 h from symptom onset, and in patients with smaller myocardial infarctions. The ISAM Study Group. Eur Heart J. 1990 Aug;11 (Suppl F):19–28. doi: 10.1093/eurheartj/11.suppl_f.19. [DOI] [PubMed] [Google Scholar]
  11. Schröder R., Wegscheider K., Schröder K., Dissmann R., Meyer-Sabellek W. Extent of early ST segment elevation resolution: a strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. A substudy of the International Joint Efficacy Comparison of Thrombolytics (INJECT) trial. J Am Coll Cardiol. 1995 Dec;26(7):1657–1664. doi: 10.1016/0735-1097(95)00372-x. [DOI] [PubMed] [Google Scholar]
  12. Simoons M. L., Maggioni A. P., Knatterud G., Leimberger J. D., de Jaegere P., van Domburg R., Boersma E., Franzosi M. G., Califf R., Schröder R. Individual risk assessment for intracranial haemorrhage during thrombolytic therapy. Lancet. 1993 Dec 18;342(8886-8887):1523–1528. doi: 10.1016/s0140-6736(05)80089-3. [DOI] [PubMed] [Google Scholar]
  13. Tobé T. J. Is thrombolytic therapy in acute inferior myocardial infarction really better than conventional treatment? Br Heart J. 1995 Feb;73(2):108–109. doi: 10.1136/hrt.73.2.108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Willems J. L., Willems R. J., Willems G. M., Arnold A. E., Van de Werf F., Verstraete M. Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. European Cooperative Study Group for Recombinant Tissue-Type Plasminogen Activator. Circulation. 1990 Oct;82(4):1147–1158. doi: 10.1161/01.cir.82.4.1147. [DOI] [PubMed] [Google Scholar]
  15. Wong C. K., Freedman S. B. Implications of ST changes in reperfusion management of acute inferior myocardial infarction. Eur Heart J. 1994 Oct;15(10):1385–1390. doi: 10.1093/oxfordjournals.eurheartj.a060399. [DOI] [PubMed] [Google Scholar]
  16. Zabriskie J. B. T-cells and T-cell clones in rheumatic fever valvulitis. Getting to the heart of the matter? Circulation. 1995 Aug 1;92(3):281–282. doi: 10.1161/01.cir.92.3.281. [DOI] [PubMed] [Google Scholar]
  17. Zehender M., Kasper W., Kauder E., Geibel A., Schönthaler M., Olschewski M., Just H. Eligibility for and benefit of thrombolytic therapy in inferior myocardial infarction: focus on the prognostic importance of right ventricular infarction. J Am Coll Cardiol. 1994 Aug;24(2):362–369. doi: 10.1016/0735-1097(94)90289-5. [DOI] [PubMed] [Google Scholar]

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