50 Journal of Electrocardiology Vol. 32 Supplement 1999

Comparison of Published ST Recovery Analysis Methods to Predict Clinical Outcome in Acute Myocardial Infarction Using a Single Digital Continuous 12-Lead ECG Data Set Arthur Maas, Christina Wyatt, Cindy Green, Mitchell Krucoff. Duke University and VA Medical Centers, Durham, NC, USA 27510

Parameters of ST-segment recovery(STREC) correlate with clinical outcome. We compared, within a single patient population of 834 patients who where enrolled in ST-monitoring substudies of 6 major thrombolytic trials, all published serial static and the Duke continuous methods of 12- lead STREC analysis versus clinical oulcome. We used a continuous ECG data stream derived from the digital 12-lead ST monitor to reproduce each published serial static STREC method comparing pre- and (1,1.5, 2, 3, and 4hrs) post treatment ECG's (at <30%,< 50% STREC thresholds) and conlinuous STREC parameters. These were analyzed versus in-hospital death and cmnbined death/re-infarction/CHF. Continuous STREC variables were: absolute ST peak(PEAK), time to stable STREC, and Late ST (re-)elevation. Significant univariable results(% or median values):

Dentil p Composite p Variable yes vs no yes vs no

120_STAT < 50% 62% vs 41% .037 50% vs 39% .004 240_STAT < 50% 54% vs 31% .014 39% vs 29% .004

PEAK (~tV) 432 vs 450 .620 543 vs 435 <.001 Time to ~table ST (rain) 139 vs 112 .575 143 vs |05 <.001

LateST 39%vs 13% <.001 23%vs 11% <.001 Multivariable analysis revealed Late ST was most predictive of mortality. A 50% serial static ECG at 4 hours added additional independent information. Continuous STREC variables provide most prognostic information content for clinical outcome. Serial static STREC methods add additional information.