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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.
- Source :
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European heart journal [Eur Heart J] 2007 Dec; Vol. 28 (24), pp. 2985-91. Date of Electronic Publication: 2007 Oct 11. - Publication Year :
- 2007
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Abstract
- 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.<br />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).<br />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.
- Subjects :
- Aged
Epidemiologic Methods
Female
Humans
Male
Middle Aged
Myocardial Infarction mortality
Myocardial Infarction therapy
Treatment Outcome
Angioplasty, Balloon, Coronary methods
Angioplasty, Balloon, Coronary mortality
Electrocardiography methods
Myocardial Infarction physiopathology
Thrombolytic Therapy methods
Thrombolytic Therapy mortality
Subjects
Details
- Language :
- English
- ISSN :
- 0195-668X
- Volume :
- 28
- Issue :
- 24
- Database :
- MEDLINE
- Journal :
- European heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 17932102
- Full Text :
- https://doi.org/10.1093/eurheartj/ehm428