Continuous 12-lead ECG monitoring to detect the need for rescue percutaneous coronary interventions in acute myocardial infarction [lean read lead]

Coronary Care Units lacking in hemodynamic facilities still rely on fibrinolytic therapy as the first line therapy of ST-elevation acute myocardial infarction. Patients not responding to therapy must receive rescue coronary angioplasty. On the basis of continuous 12-lead ECG monitoring we selected four patterns of response to therapy: 1) early and sustained reduction (>50% from baseline) of ST segment elevation was associated to patent infarct related artery (p<0.001) at coronary angiography before hospital discharge; 2) ST segment instability, 3) new sustained elevation after initial resolution, 4) persistent ST elevation were related (p<0.001) to occluded IRA. 2), 3), 4) patients received rescue PCI. In-hospital (3%) and 1-month (5.8%) mortality and 1-month (6.4%) heart failure were low and not significantly different in the four groups, confirming the clinical usefulness of this approach.