January 1, 1995Open Access
Vectorcardiographic monitoring to assess early vessel patency after reperfusion therapy for acute myocardial infarction
Key Result
Dynamic vectorcardiography correctly identified early coronary artery patency with an overall diagnostic accuracy of 80% compared to angiography.
Study Design
Type
Observational (n=96)
Structured PICO
Does dynamic vectorcardiography accurately assess early coronary artery patency compared to angiography in patients with acute myocardial infarction treated with reperfusion therapy?
P
Population
96 patients with acute myocardial infarction treated with reperfusion therapy undergoing vectorcardiographic monitoring and angiography.
E
Exposure
Dynamic vectorcardiography (continuous monitoring using trend-analysis of QRS vector difference and ST vector magnitude)
C
Comparator
Early coronary angiography
O
Outcome
Diagnostic accuracy for early coronary artery patency (reperfused vs persistently occluded infarct-related artery)surrogate
Dynamic vectorcardiography provides a non-invasive method with 80% diagnostic accuracy for assessing early coronary artery patency after reperfusion therapy in acute myocardial infarction.
Limitations
- High-grade collateral flow to the infarct-related area caused the largest disagreement between vectorcardiographic monitoring and angiography.
Abstract
Reperfusion therapy has lowered mortality in patients suffering from acute myocardial infarction. Failure to reperfuse is associated with an increased short- and long-term mortality. In a prospective study we used dynamic vectorcardiography to monitor 96 patients with acute myocardial infarction treated with reperfusion therapy to non-invasively assess coronary patency. The results from continuous monitoring were compared to those obtained from angiography. By using trend-analysis of QRS vector difference and ST vector magnitude, we were able to correctly identify 58 of the 70 patients (83%) with a reperfused infarct-related artery, and 19 of the 26 patients (73%) with a persistently occluded artery demonstrated at an early angiogram (diagnostic accuracy 80%). In patients with high-grade collateral flow to the infarct-related area, the results of the vectorcardiographic monitoring and of angiography showed the largest disagreement, whereas the accuracy of vectorcardiographic monitoring was high: 88% among patients without collaterals. The present results suggest that QRS complex and ST segment vectorcardiographic monitoring is a useful tool for assessing early coronary artery patency, and that dynamic vectorcardiography may help in identifying candidates for emergency coronary angiography.