Extent of ST-segment deviation in a single electrocardiogram lead 90 min after thrombolysis as a predictor of medium-term mortality in acute XXXX .

@entity1 @entity583
BACKGROUND: In evolving @entity583 , assessment of the sum of early resolution of ST-segment elevation (sumSTR) has become an established method to predict outcome. We have found previously that mortality is predicted more accurately by the existing ST-segment deviation in the single electrocardiograph (ECG) lead with maximum deviation (maxSTE) 90 min after start of thrombolysis. This report compares the power to predict medium-term mortality by these two approaches. METHODS: An ST-segment resolution substudy was done in conjunction with the Intravenous nPA for Treatment of Infarcting Myocardium Early (InTIME) II Study, which compared mortality in @entity1 with acute @entity583 randomly assigned lanoteplase or alteplase. In 2719 @entity1 , a 12-lead ECG was assessed at baseline and 90 min after the start of thrombolytic therapy. FINDINGS: MaxSTE achieved a better combination of sensitivities and specificities for mortality prediction than sumSTR. The area under the receiver-operating characteristic curves for 180-day mortality prediction was 0.680 for maxSTE and 0.622 for sumSTR (difference 0.058; 95% CI 0.027-0.088). Risk groups categorised at low, medium, or high risk by maxSTE comprised 43%, 32%, and 24% of @entity1 and those by complete, partial, or no sumSTR comprised 40%, 36%, and 24% of all @entity1 . The 180-day mortality rates for the three maxSTE risk groups were 3.1%, 7.1%, and 16.2%, and those for the sumSTR groups were 4.8%, 8.1%, and 11.7%. The 12-month Kaplan-Meier estimates were 4.1%, 8.8%, and 18.6%, and 5.9%, 9.9%, and 13.7%, respectively. INTERPRETATION: MaxSTE predicts early and medium-term mortality more accurately than does sumSTR. The prognosis for an individual @entity1 can be accurately estimated simply by the ST-segment deviation present in one ECG lead recorded 90 min after thrombolysis.
