Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V 1 through V3. a FRISC II substudy

Rasmus S. Ripa; Lene Holmvang; Charles Maynard; Maria Sejersten; Peter Clemmensen; Peer Grande; Bertil Lindahl; Bo Lagerqvist; Lars Wallentin; Galen S. Wagner

doi:10.1016/j.jelectrocard.2005.03.011

Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V ₁ through V₃. a FRISC II substudy

Rasmus S. Ripa, Lene Holmvang, Charles Maynard, Maria Sejersten, Peter Clemmensen, Peer Grande, Bertil Lindahl, Bo Lagerqvist, Lars Wallentin, Galen S. Wagner^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

Background: Because patients with acute left circumflex occlusion are typically characterized primarily on the standard 12-lead electrocardiogram (ECG) by ST depression, they do not qualify to receive reperfusion therapy. Documentation of a relationship between the quantities of acute ST change and final QRS estimated acute myocardial infarction (AMI) size could form the basis for clinical trials to determine the value of reperfusion therapy. Method: The Fragmin and Fast Revascularization during Instability in Coronary artery disease trial included 3214 patients with unstable coronary artery disease. Two percent of the patients (n = 69) had maximum ST-segment depression in leads V ₁ through V₃ and were selected for this study. Initial ECG changes were compared to final myocardial infarction size, using the Selvester QRS score as the end point. Results: The quantity of initial ST-segment deviation correlated with the final AMI size (r = 0.43, P < .0005). The formula 3[0.22 (ΣST↓ + ΣST↑) - 0.02], where ↓ indicates depression and ↑ elevation, derived from measurements on the initial ECG, predicted the size of the AMI in percentage of the left ventricle as estimated on the final ECG. The study population had a large proportion of AMI (73%) indicated to be in or adjacent to the posterior left ventricular wall. Conclusion: The quantitative initial ST-segment deviation correlates linearly to the final AMI size in patients with maximum ST-segment depression in leads V₁ through V_3. The formula derived could be valuable for selecting patients who fail to meet strict ST-elevation AMI criteria for emergency intravenous or intracoronary reperfusion therapy.

Original language	English
Pages (from-to)	180-186
Number of pages	7
Journal	Journal of Electrocardiology
Volume	38
Issue number	3
DOIs	https://doi.org/10.1016/j.jelectrocard.2005.03.011
Publication status	Published - 1 Jul 2005

Funding

Dr Ripa received a grant from the Danish Heart Foundation to perform the study. The ECG core laboratory at the Heart Center, Rigshospitalet, was supported through a grant from the Danish Heart Foundation. The FRISC II trial was supported by and organized in collaboration with the Pharmacia & Upjohn Company, Sweden. We gratefully appreciate the technical assistance of Beverly A. Perkins.

Keywords

AMI
Electrocardiogram
Leads

Access to Document

10.1016/j.jelectrocard.2005.03.011

Cite this

Ripa, R. S., Holmvang, L., Maynard, C., Sejersten, M., Clemmensen, P., Grande, P., Lindahl, B., Lagerqvist, B., Wallentin, L., & Wagner, G. S. (2005). Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V ₁ through V₃. a FRISC II substudy. Journal of Electrocardiology, 38(3), 180-186. https://doi.org/10.1016/j.jelectrocard.2005.03.011

Ripa, Rasmus S. ; Holmvang, Lene ; Maynard, Charles et al. / Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V ₁ through V₃. a FRISC II substudy. In: Journal of Electrocardiology. 2005 ; Vol. 38, No. 3. pp. 180-186.

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title = "Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V 1 through V3. a FRISC II substudy",

abstract = "Background: Because patients with acute left circumflex occlusion are typically characterized primarily on the standard 12-lead electrocardiogram (ECG) by ST depression, they do not qualify to receive reperfusion therapy. Documentation of a relationship between the quantities of acute ST change and final QRS estimated acute myocardial infarction (AMI) size could form the basis for clinical trials to determine the value of reperfusion therapy. Method: The Fragmin and Fast Revascularization during Instability in Coronary artery disease trial included 3214 patients with unstable coronary artery disease. Two percent of the patients (n = 69) had maximum ST-segment depression in leads V 1 through V3 and were selected for this study. Initial ECG changes were compared to final myocardial infarction size, using the Selvester QRS score as the end point. Results: The quantity of initial ST-segment deviation correlated with the final AMI size (r = 0.43, P < .0005). The formula 3[0.22 (ΣST↓ + ΣST↑) - 0.02], where ↓ indicates depression and ↑ elevation, derived from measurements on the initial ECG, predicted the size of the AMI in percentage of the left ventricle as estimated on the final ECG. The study population had a large proportion of AMI (73%) indicated to be in or adjacent to the posterior left ventricular wall. Conclusion: The quantitative initial ST-segment deviation correlates linearly to the final AMI size in patients with maximum ST-segment depression in leads V1 through V3. The formula derived could be valuable for selecting patients who fail to meet strict ST-elevation AMI criteria for emergency intravenous or intracoronary reperfusion therapy.",

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Ripa, RS, Holmvang, L, Maynard, C, Sejersten, M, Clemmensen, P, Grande, P, Lindahl, B, Lagerqvist, B, Wallentin, L & Wagner, GS 2005, 'Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V ₁ through V₃. a FRISC II substudy', Journal of Electrocardiology, vol. 38, no. 3, pp. 180-186. https://doi.org/10.1016/j.jelectrocard.2005.03.011

Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V ₁ through V₃. a FRISC II substudy. / Ripa, Rasmus S.; Holmvang, Lene; Maynard, Charles et al.
In: Journal of Electrocardiology, Vol. 38, No. 3, 01.07.2005, p. 180-186.

Research output: Contribution to journal › Article › Research › peer-review

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T1 - Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V 1 through V3. a FRISC II substudy

AU - Ripa, Rasmus S.

AU - Holmvang, Lene

AU - Maynard, Charles

AU - Sejersten, Maria

AU - Clemmensen, Peter

AU - Grande, Peer

AU - Lindahl, Bertil

AU - Lagerqvist, Bo

AU - Wallentin, Lars

AU - Wagner, Galen S.

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N2 - Background: Because patients with acute left circumflex occlusion are typically characterized primarily on the standard 12-lead electrocardiogram (ECG) by ST depression, they do not qualify to receive reperfusion therapy. Documentation of a relationship between the quantities of acute ST change and final QRS estimated acute myocardial infarction (AMI) size could form the basis for clinical trials to determine the value of reperfusion therapy. Method: The Fragmin and Fast Revascularization during Instability in Coronary artery disease trial included 3214 patients with unstable coronary artery disease. Two percent of the patients (n = 69) had maximum ST-segment depression in leads V 1 through V3 and were selected for this study. Initial ECG changes were compared to final myocardial infarction size, using the Selvester QRS score as the end point. Results: The quantity of initial ST-segment deviation correlated with the final AMI size (r = 0.43, P < .0005). The formula 3[0.22 (ΣST↓ + ΣST↑) - 0.02], where ↓ indicates depression and ↑ elevation, derived from measurements on the initial ECG, predicted the size of the AMI in percentage of the left ventricle as estimated on the final ECG. The study population had a large proportion of AMI (73%) indicated to be in or adjacent to the posterior left ventricular wall. Conclusion: The quantitative initial ST-segment deviation correlates linearly to the final AMI size in patients with maximum ST-segment depression in leads V1 through V3. The formula derived could be valuable for selecting patients who fail to meet strict ST-elevation AMI criteria for emergency intravenous or intracoronary reperfusion therapy.

AB - Background: Because patients with acute left circumflex occlusion are typically characterized primarily on the standard 12-lead electrocardiogram (ECG) by ST depression, they do not qualify to receive reperfusion therapy. Documentation of a relationship between the quantities of acute ST change and final QRS estimated acute myocardial infarction (AMI) size could form the basis for clinical trials to determine the value of reperfusion therapy. Method: The Fragmin and Fast Revascularization during Instability in Coronary artery disease trial included 3214 patients with unstable coronary artery disease. Two percent of the patients (n = 69) had maximum ST-segment depression in leads V 1 through V3 and were selected for this study. Initial ECG changes were compared to final myocardial infarction size, using the Selvester QRS score as the end point. Results: The quantity of initial ST-segment deviation correlated with the final AMI size (r = 0.43, P < .0005). The formula 3[0.22 (ΣST↓ + ΣST↑) - 0.02], where ↓ indicates depression and ↑ elevation, derived from measurements on the initial ECG, predicted the size of the AMI in percentage of the left ventricle as estimated on the final ECG. The study population had a large proportion of AMI (73%) indicated to be in or adjacent to the posterior left ventricular wall. Conclusion: The quantitative initial ST-segment deviation correlates linearly to the final AMI size in patients with maximum ST-segment depression in leads V1 through V3. The formula derived could be valuable for selecting patients who fail to meet strict ST-elevation AMI criteria for emergency intravenous or intracoronary reperfusion therapy.

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Ripa RS, Holmvang L, Maynard C, Sejersten M, Clemmensen P, Grande P et al. Consideration of the total ST-segment deviation on the initial electrocardiogram for predicting final acute posterior myocardial infarct size in patients with maximum ST-segment deviation as depression in leads V ₁ through V₃. a FRISC II substudy. Journal of Electrocardiology. 2005 Jul 1;38(3):180-186. doi: 10.1016/j.jelectrocard.2005.03.011