Continuous 12-Lean ECG Monitoring to Detect the Need for Rescue Percutaneous Coronary Interventions In Acute Myocardial Infarction

摘要

Coronary Care Units lacking in hemodynamic facilities still rely on fibrinolytic therapy as the first line therapy of ST-elevation acute myocardial infarction. Patients not responding to therapy must receive rescue coronary angioplasty. On the basis of continuous 12-lead ECG monitoring we selected four patterns of response to therapy: 1) early and sustained reduction (>50% from baseline) of ST segment elevation was associated to patent infarct related artery (p<0.001) at coronary angiography before hospital discharge; 2) ST segment instability, 3) new sustained elevation after initial resolution, 4) persistent ST elevation were related (p<0.001) to occluded IRA. 2), 3), 4) patients received rescue PCI. In-hospital (3%) and 1-month (5.8%) mortality and 1-month (6.4%) heart failure were low and not significantly different in the four groups, confirming the clinical usefulness of this approach.