USEFULNESS OF ST-SEGMENT DEPRESSION IN NON-INFARCT-RELATED ELECTROCARDIOGRAPHIC LEADS IN PREDICTING PROGNOSIS AFTER THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION

This study investigated both the in-hospital and longterm prognostic s ignificance of ST-segment depression in non-infarct-related leads in p atients who received thrombolytic therapy after acute myocardial infar ction (AMI). We evaluated 221 consecutive patients who were admitted w ith their first AMI and underwent thrombolysis. Patients were followed for an average of 31 months and were classified into 3 groups: group 1 included 51 patients with persistent ST;segment depression, group 2 had 97 patients with transient ST-segment depression, and group 3 cons isted of 73 patients without ST-segment depression (absent). Group 1 h ad significantly worse long-term survival during follow up by Kaplan-M eier analysis (55%) versus group 2 (81%) and group 3 (94%) (p = 0.0004 ) and higher event rates. This prognostic significance seemed to be ma intained in both the anterior and inferior wall AMI groups. Multivaria te analysis, using the Cox model, showed that Killip class, in-hospita l left ventricular ejection fraction, and the persistence of ST-segmen t depression on the predischarge electrocardiogram (group 1) were inde pendent predictors of survival. ST-segment depression in non-infarct-r elated leads on the predischarge electrocardiogram is an independent r isk factor for worse long-term survival after anterior as well as infe rior AMI treated with thrombolytic therapy. (C) 1997 by Excerpta Medic o, Inc.