![]() ![]() 11 All automatically assigned waveform labels were manually verified for each cardiac cycle from each subject to ensure accurate VA capture according to predefined criteria for ECG interpretation of VAs. Holter 5 software (Northeast Monitoring, Maynard, MA, USA) was used for beat-to-beat quantitative rhythm analysis on all digital 3-lead Holter recordings, as recently described. sustained for at least 4 h) ≥50% ST-recovery. Transitions between periods of ≥50% recovery from the immediately preceding peak or ST-segment re-elevation of >150 µV over preceding recovered ST-segment levels are continuously updated until stable (i.e. 14 Briefly, determination of peak ST-segment deviation is based on the lead with greatest deviation taken from the most abnormal ECG recorded during monitoring. Continuous ST-segment recovery analysisĬriteria for continuously updated 12-lead ST-segment recovery analysis and correlations with IRA patency have been described in detail. Continuous digital ECG and Holter data were encrypted and blinded to the clinical team and sent to the eECG core laboratory (eECG Core Laboratory, Duke Clinical Research Institute, Durham, NC, USA) for independent blinded continuous ST-segment recovery and quantitative rhythm analyses. 13 The NEMON system records a standard digital 12-lead ECG every 60 s in high-fidelity 720 Hz mode while simultaneously archiving beat-to-beat Holter rhythm on a digital clock synchronized to the catheterization laboratory clock for accurate correlation of ECG changes, Holter rhythm changes, and changes in IRA patency and flow. 12 Electrocardiographic data acquisitionĬontinuous 24-h digital 12-lead ECG monitoring (NEMON 180+, Northeast Monitoring, Maynard, MA, USA) was initiated prior to PCI in all subjects. TIMI flow was graded according to TIMI trial classifications. Angiographic TIMI flow assessmentĪssessments of coronary angiography for TIMI flow grades were performed by an angiographic core laboratory (Bio-Imaging Technologies, Leiden, The Netherlands) blinded to all data except for coronary angiograms. Descriptive data were collected by an independent clinical research organization and subjected to quality control and validation procedures. No drug effect on IS, ST-segment recovery, TIMI 3 flow rates, or VA rates was detected thus, for this analysis, data for all CASTEMI patients with anterior STEMI and final TIMI 3 flow after primary PCI were pooled. By protocol, all study patients had coronary angiography imaging for TIMI flow grade assessments, continuous digital 12-lead ECG and Holter monitoring, and SPECT imaging on Day 7. 1 In the current era of primary percutaneous coronary intervention (PCI), TIMI 3 epicardial flow is achieved in >80% of patients, with in-hospital and 1 year mortality rates of 20 min of chest pain with symptom onset 10 mm ST-segment elevation summed over the presenting 12-lead ECG. MACE is defined as the composite of the death of any cause, recurrence of MI, TLR, TVR, and CABG.ST-elevation myocardial infarction, Primary percutaneous coronary intervention, Continuous 12-lead ECG monitoring, Beat-to-beat Holter monitoring, Statistical outlier detection methodology, Reperfusion ventricular arrhythmia bursts IntroductionĮarly restoration of Thrombolysis in Myocardial Infarction (TIMI) 3 flow is the most effective reperfusion strategy for limiting myocardial infarct size (IS) and reducing mortality in patients with ST-elevation myocardial infarction (STEMI). TIMI: Thrombolysis in Myocardial Infarction MACE: Major Adverse Cardiac Events MI: Myocardial Infarction TVR: Target Vessel Revascularization TLR: Target Lesion Revascularization RePCI: Recurrent Percutaneous Coronary Intervention. Table 3: Comparison of various clinical outcomes according to the pre-procedural TIMI flow. Comparison of various clinical outcomes according to the pre-procedural TIMI flow. ![]()
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