Clinical Utility of Serial and Continuous ST-Segment Recovery Assessment in Patients With Acute ST-Elevation Myocardial Infarction

Abstract

Acute ST-segment–elevation myocardial infarction (STEMI) is a global source of mortality and morbidity and consequently is one of the most active areas of applied research. In the face of multiple reports of new combinations of medical and interventional therapies, the challenge to the clinician is both to understand data from key clinical trials and to translate that understanding to the individual patient at the bedside. STEMI is defined by “ST elevation” on the ECG, which is the electrical manifestation of the pathophysiological changes that follow a thrombotic occlusion of an epicardial coronary artery.1 The ECG is ubiquitous in cardiology, applied as a diagnostic, prognostic, and management tool. Although a single ECG presents about 10 seconds of waveform morphology, acute STEMI displays its dynamic behavior over time, both spontaneously and in response to therapy. The systematic use of serial and continuous ECG assessments has been one of the most fertile areas of advancement in the ability to measure and thereby recognize the presence, speed, quality, and stability of reperfusion of an infarct artery. In addition to providing insights into pathophysiological mechanisms and novel therapies in research protocols, serial or continuous use of this simple, noninvasive, quantitative measure has the potential to guide clinicians through the dynamic events surrounding the management of STEMI patients’ disease. This is illustrated in the following case studies of 3 patients, all of whom presented with 3 hours of chest pain with angiographically documented Thrombolysis in Myocardial Infarction (TIMI) 3 flow, were managed with serial ECGs for clinical purposes, and were simultaneously monitored for research protocols with “black box” continuous 12-lead ECG monitors. ### Patient 1 G.E. was a 67-year-old man with a history of hypertension and tobacco use who presented with 3 hours of chest pain. The initial ECG showed anterolateral ST-segment elevation with a maximum of 15 …