Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate invasive intervention
Abstract Purposes Reciprocal changes are frequent in patients with acute ST-segment elevation myocardial infarction (STEMI). However, their prognostic significance is not clear in patients undergoing immediate invasive intervention. Basic Procedure We retrospectively examined 165 consecutive patient...
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Veröffentlicht in: | The American journal of emergency medicine 2012-11, Vol.30 (9), p.1865-1871 |
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creator | Chen, Tien-En, MD Lo, Ping-Han, MD Li, Tsai-Chung, PhD Lin, Kuo-Hung, MD Lin, Jen-Jyh, MD Hsieh, Li-Chuan, MD Chang, Chih-Ping, MD Chen, Yeh-Peng, MD Chang, Kuan-Cheng, MD, PhD Wang, Huang-Joe, MD, PhD |
description | Abstract Purposes Reciprocal changes are frequent in patients with acute ST-segment elevation myocardial infarction (STEMI). However, their prognostic significance is not clear in patients undergoing immediate invasive intervention. Basic Procedure We retrospectively examined 165 consecutive patients with STEMI receiving immediate invasive intervention. The first electrocardiography taken in the emergency department was analyzed. Patients were assigned to 2 groups: with a reciprocal change (group I, n = 100) and without a reciprocal change (group II, n = 65). Main Findings Electrocardiographs revealed that more anterolateral and inferior STEMI occurred in group I and more anterior STEMI occurred in group II. In the emergency department, group I had lower systolic and diastolic blood pressures, higher ventricular tachycardia and fibrillation rates, and higher cardiopulmonary resuscitation rates than did group II. Upon admission, peak troponin I levels were significantly higher in group I, and more group I patients required intra-aortic balloon pumping support. This unstable hemodynamic condition in group I patients was reflected by their higher in-hospital mortality rate. Multivariate analysis showed that age (odds ratio [OR], 1.103; 95% confidence interval [CI], 1.022-1.190; P = .012), Killip class (OR, 2.785; 95% CI, 1.049-7.400; P = .040), and reciprocal change (OR, 9.553; 95% CI, 1.146-79.608; P = .037) remained as independent predictors of in-hospital mortality. Actuarial freedom from all-cause mortality was worse in group I ( P = .046). Principal Conclusions The data suggest that patients with STEMI with reciprocal electrocardiographic changes have unstable hemodynamic status and poorer outcomes. Further prospective studies using a larger patient population are needed. |
doi_str_mv | 10.1016/j.ajem.2012.03.032 |
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However, their prognostic significance is not clear in patients undergoing immediate invasive intervention. Basic Procedure We retrospectively examined 165 consecutive patients with STEMI receiving immediate invasive intervention. The first electrocardiography taken in the emergency department was analyzed. Patients were assigned to 2 groups: with a reciprocal change (group I, n = 100) and without a reciprocal change (group II, n = 65). Main Findings Electrocardiographs revealed that more anterolateral and inferior STEMI occurred in group I and more anterior STEMI occurred in group II. In the emergency department, group I had lower systolic and diastolic blood pressures, higher ventricular tachycardia and fibrillation rates, and higher cardiopulmonary resuscitation rates than did group II. Upon admission, peak troponin I levels were significantly higher in group I, and more group I patients required intra-aortic balloon pumping support. This unstable hemodynamic condition in group I patients was reflected by their higher in-hospital mortality rate. Multivariate analysis showed that age (odds ratio [OR], 1.103; 95% confidence interval [CI], 1.022-1.190; P = .012), Killip class (OR, 2.785; 95% CI, 1.049-7.400; P = .040), and reciprocal change (OR, 9.553; 95% CI, 1.146-79.608; P = .037) remained as independent predictors of in-hospital mortality. Actuarial freedom from all-cause mortality was worse in group I ( P = .046). Principal Conclusions The data suggest that patients with STEMI with reciprocal electrocardiographic changes have unstable hemodynamic status and poorer outcomes. Further prospective studies using a larger patient population are needed.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2012.03.032</identifier><identifier>PMID: 22633733</identifier><identifier>CODEN: AJEMEN</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood Pressure - physiology ; Cardiology ; Cardiopulmonary Resuscitation ; Cardiovascular disease ; Coronary Angiography ; Electrocardiography ; Emergency ; Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine ; Emergency medical care ; Emergency Service, Hospital ; Female ; Heart - physiopathology ; Heart attacks ; Hospital Mortality ; Hospitals ; Humans ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Mortality ; Multivariate analysis ; Myocardial infarction ; Myocardial Infarction - diagnosis ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Prognosis ; Retrospective Studies ; Tachycardia, Ventricular - physiopathology ; Treatment Outcome ; Troponin I - blood</subject><ispartof>The American journal of emergency medicine, 2012-11, Vol.30 (9), p.1865-1871</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c469t-8883d19679784491a90b0bc4b8a6231f3b710671f34ee88217241efa305d7c463</citedby><cites>FETCH-LOGICAL-c469t-8883d19679784491a90b0bc4b8a6231f3b710671f34ee88217241efa305d7c463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1197635180?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26680082$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22633733$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Tien-En, MD</creatorcontrib><creatorcontrib>Lo, Ping-Han, MD</creatorcontrib><creatorcontrib>Li, Tsai-Chung, PhD</creatorcontrib><creatorcontrib>Lin, Kuo-Hung, MD</creatorcontrib><creatorcontrib>Lin, Jen-Jyh, MD</creatorcontrib><creatorcontrib>Hsieh, Li-Chuan, MD</creatorcontrib><creatorcontrib>Chang, Chih-Ping, MD</creatorcontrib><creatorcontrib>Chen, Yeh-Peng, MD</creatorcontrib><creatorcontrib>Chang, Kuan-Cheng, MD, PhD</creatorcontrib><creatorcontrib>Wang, Huang-Joe, MD, PhD</creatorcontrib><title>Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate invasive intervention</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Abstract Purposes Reciprocal changes are frequent in patients with acute ST-segment elevation myocardial infarction (STEMI). However, their prognostic significance is not clear in patients undergoing immediate invasive intervention. Basic Procedure We retrospectively examined 165 consecutive patients with STEMI receiving immediate invasive intervention. The first electrocardiography taken in the emergency department was analyzed. Patients were assigned to 2 groups: with a reciprocal change (group I, n = 100) and without a reciprocal change (group II, n = 65). Main Findings Electrocardiographs revealed that more anterolateral and inferior STEMI occurred in group I and more anterior STEMI occurred in group II. In the emergency department, group I had lower systolic and diastolic blood pressures, higher ventricular tachycardia and fibrillation rates, and higher cardiopulmonary resuscitation rates than did group II. Upon admission, peak troponin I levels were significantly higher in group I, and more group I patients required intra-aortic balloon pumping support. This unstable hemodynamic condition in group I patients was reflected by their higher in-hospital mortality rate. Multivariate analysis showed that age (odds ratio [OR], 1.103; 95% confidence interval [CI], 1.022-1.190; P = .012), Killip class (OR, 2.785; 95% CI, 1.049-7.400; P = .040), and reciprocal change (OR, 9.553; 95% CI, 1.146-79.608; P = .037) remained as independent predictors of in-hospital mortality. Actuarial freedom from all-cause mortality was worse in group I ( P = .046). Principal Conclusions The data suggest that patients with STEMI with reciprocal electrocardiographic changes have unstable hemodynamic status and poorer outcomes. Further prospective studies using a larger patient population are needed.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure - physiology</subject><subject>Cardiology</subject><subject>Cardiopulmonary Resuscitation</subject><subject>Cardiovascular disease</subject><subject>Coronary Angiography</subject><subject>Electrocardiography</subject><subject>Emergency</subject><subject>Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Heart - physiopathology</subject><subject>Heart attacks</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Tachycardia, Ventricular - physiopathology</subject><subject>Treatment Outcome</subject><subject>Troponin I - blood</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kt-L1DAQx4Mo3rr6D_ggARF86ZofbZKCCHKcenCicOdzSNPpmrVN16RduWf_cafs6sE9CAMJyWe-zMx3CHnO2YYzrt7sNm4Hw0YwLjZMYogHZMUrKQrDNX9IVkzLqlC60mfkSc47xjgvq_IxORNCSamlXJHfX9O4jWOegqc5bGPognfRAx07msCHfRq96-n1TZFhO0CcaAv7BDmHMdIQ6d5NAV8z_RWm79T5eQKELz5f0jm2kLZjiFsahgHa4PArxIPL4bBcJkgHzESdp-RR5_oMz07nmnz7cHFz_qm4-vLx8vz9VeFLVU-FMUa2vFa61qYsa-5q1rDGl41xSkjeyUZzpjReSgBjBNei5NA5yapWo4Rck9dHXWzq5wx5skPIHvreRRjnbDnXRmlVotqavLyH7sY5RawOqVorWXHDkBJHyqcx5wSd3acwuHRrObOLRXZnF4vsYpFlEmORfnGSnhscy7-Uv54g8OoEuIyz7xL6EfIdp5RhzCxCb48c4MwOAZLNHr3wOGp0brLtGP5fx7t76b4PEd3vf8At5Lt-bcYce70s07JLXOAeVcrIP3dBxEY</recordid><startdate>20121101</startdate><enddate>20121101</enddate><creator>Chen, Tien-En, MD</creator><creator>Lo, Ping-Han, MD</creator><creator>Li, Tsai-Chung, PhD</creator><creator>Lin, Kuo-Hung, MD</creator><creator>Lin, Jen-Jyh, MD</creator><creator>Hsieh, Li-Chuan, MD</creator><creator>Chang, Chih-Ping, MD</creator><creator>Chen, Yeh-Peng, MD</creator><creator>Chang, Kuan-Cheng, MD, PhD</creator><creator>Wang, Huang-Joe, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20121101</creationdate><title>Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate invasive intervention</title><author>Chen, Tien-En, MD ; Lo, Ping-Han, MD ; Li, Tsai-Chung, PhD ; Lin, Kuo-Hung, MD ; Lin, Jen-Jyh, MD ; Hsieh, Li-Chuan, MD ; Chang, Chih-Ping, MD ; Chen, Yeh-Peng, MD ; Chang, Kuan-Cheng, MD, PhD ; Wang, Huang-Joe, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c469t-8883d19679784491a90b0bc4b8a6231f3b710671f34ee88217241efa305d7c463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure - physiology</topic><topic>Cardiology</topic><topic>Cardiopulmonary Resuscitation</topic><topic>Cardiovascular disease</topic><topic>Coronary Angiography</topic><topic>Electrocardiography</topic><topic>Emergency</topic><topic>Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Heart - physiopathology</topic><topic>Heart attacks</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Tachycardia, Ventricular - physiopathology</topic><topic>Treatment Outcome</topic><topic>Troponin I - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Tien-En, MD</creatorcontrib><creatorcontrib>Lo, Ping-Han, MD</creatorcontrib><creatorcontrib>Li, Tsai-Chung, PhD</creatorcontrib><creatorcontrib>Lin, Kuo-Hung, MD</creatorcontrib><creatorcontrib>Lin, Jen-Jyh, MD</creatorcontrib><creatorcontrib>Hsieh, Li-Chuan, MD</creatorcontrib><creatorcontrib>Chang, Chih-Ping, MD</creatorcontrib><creatorcontrib>Chen, Yeh-Peng, MD</creatorcontrib><creatorcontrib>Chang, Kuan-Cheng, MD, PhD</creatorcontrib><creatorcontrib>Wang, Huang-Joe, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Tien-En, MD</au><au>Lo, Ping-Han, MD</au><au>Li, Tsai-Chung, PhD</au><au>Lin, Kuo-Hung, MD</au><au>Lin, Jen-Jyh, MD</au><au>Hsieh, Li-Chuan, MD</au><au>Chang, Chih-Ping, MD</au><au>Chen, Yeh-Peng, MD</au><au>Chang, Kuan-Cheng, MD, PhD</au><au>Wang, Huang-Joe, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate invasive intervention</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2012-11-01</date><risdate>2012</risdate><volume>30</volume><issue>9</issue><spage>1865</spage><epage>1871</epage><pages>1865-1871</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><coden>AJEMEN</coden><abstract>Abstract Purposes Reciprocal changes are frequent in patients with acute ST-segment elevation myocardial infarction (STEMI). However, their prognostic significance is not clear in patients undergoing immediate invasive intervention. Basic Procedure We retrospectively examined 165 consecutive patients with STEMI receiving immediate invasive intervention. The first electrocardiography taken in the emergency department was analyzed. Patients were assigned to 2 groups: with a reciprocal change (group I, n = 100) and without a reciprocal change (group II, n = 65). Main Findings Electrocardiographs revealed that more anterolateral and inferior STEMI occurred in group I and more anterior STEMI occurred in group II. In the emergency department, group I had lower systolic and diastolic blood pressures, higher ventricular tachycardia and fibrillation rates, and higher cardiopulmonary resuscitation rates than did group II. Upon admission, peak troponin I levels were significantly higher in group I, and more group I patients required intra-aortic balloon pumping support. This unstable hemodynamic condition in group I patients was reflected by their higher in-hospital mortality rate. Multivariate analysis showed that age (odds ratio [OR], 1.103; 95% confidence interval [CI], 1.022-1.190; P = .012), Killip class (OR, 2.785; 95% CI, 1.049-7.400; P = .040), and reciprocal change (OR, 9.553; 95% CI, 1.146-79.608; P = .037) remained as independent predictors of in-hospital mortality. Actuarial freedom from all-cause mortality was worse in group I ( P = .046). Principal Conclusions The data suggest that patients with STEMI with reciprocal electrocardiographic changes have unstable hemodynamic status and poorer outcomes. Further prospective studies using a larger patient population are needed.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22633733</pmid><doi>10.1016/j.ajem.2012.03.032</doi><tpages>7</tpages></addata></record> |
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subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Pressure - physiology Cardiology Cardiopulmonary Resuscitation Cardiovascular disease Coronary Angiography Electrocardiography Emergency Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine Emergency medical care Emergency Service, Hospital Female Heart - physiopathology Heart attacks Hospital Mortality Hospitals Humans Intensive care medicine Male Medical sciences Middle Aged Mortality Multivariate analysis Myocardial infarction Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - therapy Prognosis Retrospective Studies Tachycardia, Ventricular - physiopathology Treatment Outcome Troponin I - blood |
title | Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate invasive intervention |
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