Impact of the electrocardiogram on the delivery of thrombolytic therapy for acute myocardial infarction
| Autor: | Timothy D. Henry, Charlene R. Berger, Douglas D. Brunette, Scott W. Sharkey |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Benign early repolarization medicine.medical_treatment Streptokinase Myocardial Infarction Chest pain Electrocardiography Internal medicine medicine Humans Thrombolytic Therapy Hospital Mortality cardiovascular diseases Myocardial infarction medicine.diagnostic_test business.industry Thrombolysis Emergency department Middle Aged medicine.disease Tissue Plasminogen Activator Cardiology Regression Analysis Female Myocardial infarction diagnosis Emergencies medicine.symptom Emergency Service Hospital Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | The American Journal of Cardiology. 73:550-553 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/0002-9149(94)90331-x |
| Popis: | The initial electrocardiogram is crucial in accurately selecting patients with chest pain for thrombolytic therapy. An electrocardiogram with a large amount of ST-segment elevation and depression is "visually alarming," and therefore, may influence the efficiency of patient treatment with thrombolytic therapy. It was hypothesized that the amount of ST-segment deviation present on the initial electrocardiogram was an important variable in determining the time to initiation of thrombolysis in the emergency department. The time from arrival at the emergency department to thrombolysis was measured in 93 consecutive patients with suspected acute myocardial infarction (AMI) who were treated with intravenous thrombolytic therapy by emergency department physicians. This was correlated with the sum of ST-segment elevation and depression present on the initial electrocardiogram. AMI was proved in 83 patients (89%). In patients with proved AMI, the average time to thrombolysis was 50.8 +/- 25.6 minutes. Treatment began within the goal ofor = 30 minutes in 18 patients (22%) and was excessively delayed ator = 60 minutes in 24 (29%). Regression analysis of multiple clinical variables revealed that ST-segment sum was the only variable that significantly influenced the time to thrombolysis (r = -0.42; p0.001). For patients treated inor = 30 minutes, the average ST-segment sum was 21.1 +/- 13.5 vs 11.5 +/- 11.4 mm for those treated inor = 60 minutes (p = 0.01). In 10 patients mistakenly treated with thrombolytic therapy, the electrocardiographic processes responsible for ST-segment elevation included the early repolarization variant, left ventricular hypertrophy, old anterior AMI with persistent ST-segment elevation, and conduction delay.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Databáze: | OpenAIRE |
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