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PERSISTENT ST SEGMENT ELEVATION/DEPRESSION IN MYOCARDIAL INFARCTION PATIENTS AND ITS VALUE IN PREDICTING SHORT-TERM POST-HOSPITAL OUTCOMES

Abstract

Electrocardiography is the most accessible and widely used method for diagnosing myocardial infarction (MI) and predicting MI outcomes. This paper presents the results of the prospective study, assessing ST segment dynamics in 248 MI patients and evaluating its role in predicting short-term (3 months) post-hospital MI outcomes. At least once (at admission, at Days 6-8, or at discharge), ST segment elevation was registered in 117 MI patients (47%), and ST segment depression – in 134 (54%). Among these participants, persistent ST elevation/depression, registered at all control points, was observed only in 15%: two thirds (26 out of 37) had persistent ST elevation, and the others – persistent ST depression. During the three-month follow-up period, a combined endpoint (cardiovascular death, non-fatal MI, stroke, or unstable angina) was registered in 48 participants (19,7%; the endpoint was evaluated in 245 patients with known post-hospital outcomes). Independent predictors of poor post-hospital MI prognosis included persistent ST elevation (odds ratio 2,9; 95% confidence interval 1,2-7,0) and persistent ST depression (odds ratio 4,3; 1,2-14,8), but not episodic, non-persistent ST elevation/depression.

About the Authors

S. V. Semakina
Городская клиническая больница №7, Москва
Russian Federation


R. T. Saygitov
Городская клиническая больница №59,Москва
Russian Federation


M. G. Glezer
Городская клиническая больница №59,Москва; Научно-исследовательский центр ММА им. И.М. Сеченова, Москва
Russian Federation


References

1. Оганов Р.Г. Профилактика сердечно-сосудистых заболеваний в России: успехи, неудачи, перспективы // Терапевтический архив. 2004; 6: 22-24.

2. Протокол пленарного заседания Московского Городского Научного Общества Терапевтов от 25.02.2004 г. // Вестник Московского городского научного общества терапевтов. 2006; 17.

3. Секриеру Е.М., Моравская С.В., Захарова А.Б. Некоторые особенности формирования статистики госпитальной заболеваемости по данным федеральной отчетности // Информационно- аналитический вестник. Социальные аспекты здоровья населения. 2009; 3(11).

4. Сайгитов Р.Т. Острый коронарный синдром: клинико-генетические аспекты прогнозирования и профилактики / Автореф. дисс. …докт.мед.наук. М., 2007. 47.

5. Schechtman K.B., Capone R.J., Kleiger R.E. et al Differential risk patterns associated with 3 month as compared with 3 to 12 month mortality and reinfarction after non-Q wave myocardial infarction. The Diltiazem Reinfarction Study Group// J Am Coll Cardiol. 1990;15(5):940-7.

6. Petrina M., Goodman S.G., Eagle K.A. The 12-lead electrocardiogram as a predictive tool of mortality after acute myocardial infarction: current status in an era of revascularization and reperfusion// Am Heart J. 2006;152(1):11-8.

7. Jernberg Y., Lindahl B., Wallentin L. ST-segment monitoring with continuous 12-lead ECG improves early risk stratification in patients with chest pain and ECG nondiagnostic of acute myocardial infarction// J Am Coll Cardiol. 1999;34(5):1413-9.

8. Zairis M.N., Lycas A.G., Makrygiannis S.S. et al. Continuous 12-lead electrocardiographic ST monitoring adds prognostic information to the thrombolysis in myocardial infarction risk score in patients with non-ST-elevation acute coronary syndromes//Clin Cardiol. 2005;28(4):189-92.

9. Hersi A., Fu Y., Wong B. et al. Does the discharge ECG provide additional prognostic insight (s) in non-ST elevation ACS patients from that acquired on admission?// Eur Heart J. 2003;24(6):522- 31.

10. Antman E.M., Cohen M., Bernink P.J. et al. The risk score for unstable angina/non- ST elevation MI: A method for prognostication and therapeutic decision making// JAMA. 2000;284(7):835-42.

11. Christiansen J.P., Liang C.S. Reappraisal of the Norris score and the prognostic value of left ventricular ejection fraction measurement for in-hospital mortality after acute myocardial infartion//Am J Cardiol. 1999;83(4):589-91.

12. Granger C.B., Goldberg R.J., Dabbous O.M. et al. Predictors of hospital mortality in the Global Registry of Acute Coronary Events// Arch Int Med. 2003;163(19):2345-53.

13. Birnbaum Y., Drew B.J. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis// Postgrad Med J. 2003;79(935):490-504.

14. Pereztol-Valdés O., Candell-Riera J., Santana-Boado C. et al. Correspondence between left ventricular 17 myocardial segments and coronary arteries//Eur Heart J. 2005;26(24):2637-43.

15. Ortiz-Pérez J.T., Rodríguez J., Meyers S.N. et al. Correspondence between the 17-segment model and coronary arterial anatomy using contrast-enhanced cardiac magnetic resonance imaging// JACC Cardiovasc Imaging. 2008;1(3):282-93.

16. Roul G., Bareiss P., Germain P. et al. Isolated ST segment depression from V2 to V4 leads, an early electrocardiographic sign of posterior myocardial infarction // Arch Mal Coeur Vaiss. 1991;84(12):1815-9.

17. Brady W.J. Acute posterior wall myocardial infarction: electrocardiographic manifestations//Am J Emerg Med. 1998;16(4):409-13.

18. Sgarbossa E.B., Pinski S.L., Barbagelata A. et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle branch block// N Engl J Med. 1996;334:481–7.

19. Nikus K.C., Eskola M.J. Electrocardiogram patterns in acute left main coronary artery occlusion// J Electrocardiol. 2008;41(6):626-9.

20. Savonitto S., Cohen M.G., Politi A. et al. Extent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes//Eur Heart J. 2005;26(20):2106-13.

21. Shah A., Wagner G.S., Green C.L. et al. Electrocardiographic differentiation of the ST-segment depression of acute myocardial injury due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies//Am J Cardiol. 1997;80(4):512-3.

22. Pollehn T., Brady W.J., Perron A.D., Morris F. The electrocardiographic differential diagnosis of ST segment depressionn// Emerg Med J. 2002;19(2):129-35.


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For citations:


Semakina S.V., Saygitov R.T., Glezer M.G. PERSISTENT ST SEGMENT ELEVATION/DEPRESSION IN MYOCARDIAL INFARCTION PATIENTS AND ITS VALUE IN PREDICTING SHORT-TERM POST-HOSPITAL OUTCOMES. Russian Journal of Cardiology. 2010;(3):4-11. (In Russ.)

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ISSN 1560-4071 (Print)
ISSN 2618-7620 (Online)