Characteristics and prognostic importance of ST-segment elevation on Holter monitoring early after acute myocardial infarction

H Mickley, J R Nielsen, J Berning, A Junker, M Møller

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

The correlation between episodes of ST-segment elevation on Holter monitoring, clinical characteristics, left ventricular function, exercise testing, and long-term prognosis was determined in 123 consecutive patients 55 +/- 8 years old (mean +/- SD) with a first acute myocardial infarction (AMI). During 36 hours of Holter recording 11 +/- 5 days after AMI, 11 patients (9%) had 91 episodes of ST-segment elevation (group 1), whereas 112 patients had no such episodes (group 2). Most episodes of ST-segment elevation occurred in leads with pathologic Q waves or small, indistinct R waves. Large, anterior Q-wave AMIs were more prevalent in group 1 than in group 2, and in-hospital heart failure also occurred more frequently in group 1 patients (82% vs 23%; p < 0.0005). Regional and global left ventricular function was reduced in group 1 compared with group 2: ejection fraction 33 +/- 11% vs 50 +/- 11% (p = 0.0001). All episodes of ST-segment elevation were asymptomatic and did not correlate with different indicators of myocardial ischemia. Indeed, exercise-induced ST-segment depression was more prevalent in group 2 than in group 1: 57 vs 18% (p < 0.035). Over a mean of 5 years (range 4 to 6) of follow-up, an association between episodes of ST-segment elevation on Holter monitoring and (1) cardiac death (Kaplan-Meier analysis; p < 0.005), and (2) cardiac death and nonfatal reinfarction (Kaplan-Meier analysis; p < 0.025) was found.(ABSTRACT TRUNCATED AT 250 WORDS)
Original languageEnglish
JournalAmerican Journal of Cardiology
Volume76
Issue number8
Pages (from-to)537-42
Number of pages5
ISSN0002-9149
Publication statusPublished - 15. Sep 1995

Keywords

  • Echocardiography
  • Electrocardiography, Ambulatory
  • Exercise Test
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Myocardial Infarction
  • Prognosis
  • Statistics, Nonparametric
  • Survival Analysis
  • Time Factors
  • Ventricular Function, Left

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