PMID- 23299490
OWN - NLM
STAT- MEDLINE
DCOM- 20130228
LR  - 20211021
IS  - 1940-087X (Electronic)
IS  - 1940-087X (Linking)
IP  - 70
DP  - 2012 Dec 28
TI  - A research method for detecting transient myocardial ischemia in patients with 
      suspected acute coronary syndrome using continuous ST-segment analysis.
LID - 50124 [pii]
LID - 10.3791/50124 [doi]
AB  - Each year, an estimated 785,000 Americans will have a new coronary attack, or 
      acute coronary syndrome (ACS). The pathophysiology of ACS involves rupture of an 
      atherosclerotic plaque; hence, treatment is aimed at plaque stabilization in 
      order to prevent cellular death. However, there is considerable debate among 
      clinicians, about which treatment pathway is best: early invasive using 
      percutaneous coronary intervention (PCI/stent) when indicated or a conservative 
      approach (i.e., medication only with PCI/stent if recurrent symptoms occur). 
      There are three types of ACS: ST elevation myocardial infarction (STEMI), non-ST 
      elevation MI (NSTEMI), and unstable angina (UA). Among the three types, NSTEMI/UA 
      is nearly four times as common as STEMI. Treatment decisions for NSTEMI/UA are 
      based largely on symptoms and resting or exercise electrocardiograms (ECG). 
      However, because of the dynamic and unpredictable nature of the atherosclerotic 
      plaque, these methods often under detect myocardial ischemia because symptoms are 
      unreliable, and/or continuous ECG monitoring was not utilized. Continuous 12-lead 
      ECG monitoring, which is both inexpensive and non-invasive, can identify 
      transient episodes of myocardial ischemia, a precursor to MI, even when 
      asymptomatic. However, continuous 12-lead ECG monitoring is not usual hospital 
      practice; rather, only two leads are typically monitored. Information obtained 
      with 12-lead ECG monitoring might provide useful information for deciding the 
      best ACS treatment. Purpose. Therefore, using 12-lead ECG monitoring, the COMPARE 
      Study (electroCardiographic evaluatiOn of ischeMia comParing invAsive to 
      phaRmacological trEatment) was designed to assess the frequency and clinical 
      consequences of transient myocardial ischemia, in patients with NSTEMI/UA treated 
      with either early invasive PCI/stent or those managed conservatively (medications 
      or PCI/stent following recurrent symptoms). The purpose of this manuscript is to 
      describe the methodology used in the COMPARE Study. Method. Permission to proceed 
      with this study was obtained from the Institutional Review Board of the hospital 
      and the university. Research nurses identify hospitalized patients from the 
      emergency department and telemetry unit with suspected ACS. Once consented, a 
      12-lead ECG Holter monitor is applied, and remains in place during the patient's 
      entire hospital stay. Patients are also maintained on the routine bedside ECG 
      monitoring system per hospital protocol. Off-line ECG analysis is done using 
      sophisticated software and careful human oversight.
FAU - Pelter, Michele M
AU  - Pelter MM
AD  - Orvis School of Nursing, University of Nevada, Reno, Nevada, USA. mpelter@unr.edu
FAU - Kozik, Teri M
AU  - Kozik TM
FAU - Loranger, Denise L
AU  - Loranger DL
FAU - Carey, Mary G
AU  - Carey MG
LA  - eng
GR  - K23 NR009716/NR/NINR NIH HHS/United States
GR  - R21 NR011202/NR/NINR NIH HHS/United States
GR  - R21 NR-009716/NR/NINR NIH HHS/United States
GR  - R21 NR-011202/NR/NINR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Video-Audio Media
DEP - 20121228
PL  - United States
TA  - J Vis Exp
JT  - Journal of visualized experiments : JoVE
JID - 101313252
SB  - IM
MH  - Acute Coronary Syndrome/*diagnosis/physiopathology
MH  - Electrocardiography/instrumentation/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Monitoring, Physiologic/instrumentation/methods
MH  - Myocardial Ischemia/*diagnosis/physiopathology
PMC - PMC3577868
EDAT- 2013/01/10 06:00
MHDA- 2013/03/01 06:00
PMCR- 2013/12/28
CRDT- 2013/01/10 06:00
PHST- 2013/01/10 06:00 [entrez]
PHST- 2013/01/10 06:00 [pubmed]
PHST- 2013/03/01 06:00 [medline]
PHST- 2013/12/28 00:00 [pmc-release]
AID - 50124 [pii]
AID - 10.3791/50124 [doi]
PST - epublish
SO  - J Vis Exp. 2012 Dec 28;(70):50124. doi: 10.3791/50124.