Prognostic Significance of ST Segment Shift Early After Resolution of ST Elevation in Patients With Myocardial Infarction Treated With Thrombolytic Therapy: The GUSTO-I ST Segment Monitoring Substudy 11This study was supported by Genentech Canada Inc., Toronto, Ontario, Canada; Kabi Vitrum, Sweden; Bayer, New York, New York; Sanofi Pharmaceuticals, Paris, France; ICI Pharmaceuticals, Wilmington, Delaware; Marquette Electronics, Milwaukee, Wisconsin; Ortivus Medical, Stockholm, Sweden; and Mortara Instrument, Milwaukee, Wisconsin.

Hackett, 1987, Intermittent coronary occlusion in acute myocardial infarction, N Engl J Med, 317, 1055, 10.1056/NEJM198710223171704 Krucoff, 1990, The portable programmable microprocessor-driven real-time 12-lead electrocardiographic monitor, Am J Cardiol, 65, 143, 10.1016/0002-9149(90)90075-C Clemmensen, 1990, Changes in standard electrocardiographic ST-segment elevation predictive of successful reperfusion in acute myocardial infarction, Am J Cardiol, 66, 1407, 10.1016/0002-9149(90)90524-5 Dellborg, 1991, Dynamic QRS complex and ST-segment vectorcardiographic monitoring can identify vessel patency in patients with acute myocardial infarction treated with reperfusion therapy, Am Heart J, 122, 943, 10.1016/0002-8703(91)90455-Q Dellborg, 1991, Dynamic QRS complex and ST segment monitoring in acute myocardial infarction during recombinant tissue-type plasminogen activator therapy, Am J Cardiol, 67, 343, 10.1016/0002-9149(91)90039-N Krucoff, 1993, Continuously updated 12-lead ST-segment recovery analysis for myocardial infarct artery patency assessment and its correlation with multiple simultaneous early angiographic observations, Am J Cardiol, 71, 145, 10.1016/0002-9149(93)90729-V Shah, 1993, Angiographic validation of bedside markers of perfusion, J Am Coll Cardiol, 21, 55, 10.1016/0735-1097(93)90716-E Kondo, 1993, Is ST segment reelevation associated with reperfusion an indicator of marked myocardial damage after thrombolysis?, J Am Coll Cardiol, 21, 62, 10.1016/0735-1097(93)90717-F Langer A, Krucoff MW, Klootwijk P, et al, for the GUSTO Investigators. Noninvasive assessment of speed and stability of infarct-related artery reperfusion: results of the GUSTO ST Segment Monitoring Study. J Am Coll Cardiol 1995;25:1552–7. von Arnim, 1988, Prognostic implications of transient—predominantly silent—ischaemia in patients with unstable angina pectoris, Eur Heart J, 9, 435, 10.1093/oxfordjournals.eurheartj.a062521 Nademanee, 1987, Prognostic significance of silent myocardial ischemia in patients with unstable angina, J Am Coll Cardiol, 10, 1, 10.1016/S0735-1097(87)80152-3 Gottlieb, 1987, Silent ischemia predicts infarction and death during 2-year follow-up of unstable angina, J Am Coll Cardiol, 10, 756, 10.1016/S0735-1097(87)80267-X Johnson, 1982, Continuous electrocardiographic monitoring in patients with unstable angina pectoris, Am Heart J, 103, 4, 10.1016/0002-8703(82)90522-1 Langer, 1989, ST segment shift in unstable angina, J Am Coll Cardiol, 13, 1495, 10.1016/0735-1097(89)90338-0 Langer, 1995, Detection of silent ischemia adds to the prognostic value of coronary anatomy and left ventricular function in predicting outcome in unstable angina patients, Can J Cardiol, 11, 117 Ouyang, 1990, Frequency and importance of silent myocardial ischemia identified with ambulatory electrocardiographic monitoring in the early in-hospital period after acute myocardial infarction, Am J Cardiol, 65, 267, 10.1016/0002-9149(90)90285-9 Gottlieb, 1988, Silent ischemia on Holter monitoring predicts mortality in high-risk postinfarction patients, JAMA, 259, 1030, 10.1001/jama.1988.03720070030029 Tzivoni, 1988, Prognostic significance of ischemic episodes in patients with previous myocardial infarction, Am J Cardiol, 62, 661, 10.1016/0002-9149(88)91198-8 Langer A, Minkowitz J, Dorian P, et al, for the Tissue Plasminogen Activator: Toronto (T-PAT) Study Group. Pathophysiology and prognostic significance of Holter-detected ST segment depression after myocardial infarction. J Am Coll Cardiol 1992;20:1313–7. Solimene, 1993, Prognostic significance of silent myocardial ischemia after a first uncomplicated myocardial infarction, Int J Cardiol, 38, 41, 10.1016/0167-5273(93)90202-R Silva P, Galli M, Campolo L, for the IRES (Ischemia Residua) Study Group. Prognostic significance of early ischemia after acute myocardial infarction in low-risk patients. Am J Cardiol 1993;71:1142–7. Gill, 1996, Prognostic importance of myocardial ischemia detected by ambulatory monitoring early after acute myocardial infarction, N Engl J Med, 334, 65, 10.1056/NEJM199601113340201 Betriu, 1992, Unstable angina, J Am Coll Cardiol, 19, 1659, 10.1016/0735-1097(92)90633-X Cohen, 1991, Usefulness of ST-segment changes in greater than or equal to 2 leads on the emergency room electrocardiogram in either unstable angina pectoris or non-Q wave myocardial infarction in predicting outcome, Am J Cardiol, 67, 1368, 10.1016/0002-9149(91)90467-Y Langer, 1990, Relation to angiographic detected intracoronary thrombus and silent myocardial ischemia in unstable angina pectoris, Am J Cardiol, 66, 1381, 10.1016/0002-9149(90)91175-6 Serneri, 1993, Silent ischemia in unstable angina is related to an altered cardiac norepinephrine handling, Circulation, 87, 1928, 10.1161/01.CIR.87.6.1928 Gurfinkel, 1994, Importance of thrombosis and thrombolysis in silent ischaemia, Br Heart J, 71, 151, 10.1136/hrt.71.2.151 1993, An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction, N Engl J Med, 329, 673, 10.1056/NEJM199309023291001 1993, The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction, N Engl J Med, 329, 1615, 10.1056/NEJM199311253292204 Krucoff, 1994, Global Utilization of Streptokinase and TPA for Occluded Arteries (GUSTO) ECG Monitoring Substudy, J Electrocardiol, 26, 249 Lee KL, Woodlief LH, Topol EJ, et al, for the GUSTO-I Investigators. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction: Results from an international trial of 41,021 patients. Circulation 1995;91:1659–68. Pepine, 1990, Is silent ischemia a treatable risk factor in patients with angina pectoris?, Circulation, 82, 135 Fernandez, 1995, ST segment tracking for rapid determination of patency of the infarct-related artery in acute myocardial infarction, J Am Coll Cardiol, 26, 675, 10.1016/0735-1097(95)00208-L Timmis, 1995, ST segment analysis for determining the dynamic status of reperfusion therapy, J Am Coll Cardiol, 25, 684, 10.1016/0735-1097(95)00310-Z Klootwijk, 1996, Non-invasive prediction of reperfusion and coronary artery patency by continuous ST-segment monitoring in the GUSTO-I trial, Eur Heart J, 17, 689, 10.1093/oxfordjournals.eurheartj.a014935 Fox, 1983, Significant of exercise-induced ST-segment elevation in patients with previoius myocardial infarction, Br Heart J, 49, 15, 10.1136/hrt.49.1.15 Coma-Canella, 1994, Radionuclide studies in patients with stress-induced ST-segment elevation after acute myocardial infarction, Am Heart J, 128, 459, 10.1016/0002-8703(94)90617-3 Elhendy, 1996, Stress-induced ST-segment elevation after a recent myocardial infarction, Eur Heart J, 17, 975, 10.1093/oxfordjournals.eurheartj.a015015 Dorian, 1994, Importance of ST-segment depression as a determinant of ventricular premature complex frequency after thrombolysis for acute myocardial infarction, Am J Cardiol, 74, 419, 10.1016/0002-9149(94)90895-8 Ohman EM, Armstrong PW, Christenson RH, et al., for the GUSTO-IIa Investigators. Cardiac troponin T levels for risk stratification in acute myocardial ischemia. N Engl J Med 1996;335:1333–41. Antman, 1996, Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes, N Engl J Med, 335, 1342, 10.1056/NEJM199610313351802 Topol, 1987, A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction, N Engl J Med, 317, 581, 10.1056/NEJM198709033171001 Guerci, 1987, A randomized trial of intravenous tissue plasminogen activator for acute myocardial infarction with subsequent randomization to elective coronary angioplasty, N Engl J Med, 317, 1613, 10.1056/NEJM198712243172601 Simoons, 1988, Thrombolysis with tissue plasminogen activator in acute myocardial infarction, Lancet, 1, 197, 10.1016/S0140-6736(88)91062-8 1988, Immediate vs delayed catheterization and angioplasty following thrombolytic therapy for acute myocardial infarction, JAMA, 260, 2849, 10.1001/jama.1988.03410190097031 1989, Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction, N Engl J Med, 320, 618, 10.1056/NEJM198903093201002 Rogers WJ, Baim DS, Gore JM, et al., for the TIMI II-A Investigators. Comparison of immediate invasive, delayed invasive, and conservative strategies after tissue-type plasminogen activator: results of the Thrombolysis in Myocardial Infarction (TIMI) phase II-A trial. Circulation 1990;81:1457–76. Barbash, 1990, Randomized controlled trial of late in-hospital angiography and angioplasty versus conservative management after treatment with recombinant tissue-type plasminogen activator in acute myocardial infarction, Am J Cardiol, 66, 538, 10.1016/0002-9149(90)90478-J 1991, SWIFT Trial of delayed elective intervention vs conservative treatment after thrombolysis with anistreplase in acute myocardial infarction, BMJ, 302, 555, 10.1136/bmj.302.6776.555 Topol, 1992, A randomized trial of late reperfusion therapy for acute myocardial infarction, Circulation, 85, 2090, 10.1161/01.CIR.85.6.2090 Ellis SG, Mooney MR, George BS, et al., for the Treatment of Post-Thrombolytic Stenosis (TOPS) Study Group. Randomized trial of late elective angioplasty versus conservative management for patients with residual stenosis after thrombolytic treatment of myocardial infarction. Circulation 1992;86:1400–6.