Estimating the extent of myocardial damage in patients with STEMI using the DETERMINE score

Abstract

BackgroundRecently, a simple ECG score (DETERMINE score) has been proposed for estimating myocardial scar in patients with ischaemic cardiomyopathy. We sought to evaluate the usefulness of the DETERMINE score for the assessment of myocardial infarct size (IS) as well as microvascular obstruction (MVO), in the setting of ST-elevation myocardial infarction (STEMI).MethodsThis observational study enrolled 423 patients with STEMI (median age 56, 17% women), revascularised by primary percutaneous coronary intervention (PCI). For evaluation of the DETERMINE and Selvester scoring system (an established but complex ECG score for IS estimation), ECG was conducted before discharge (median: 4 (IQR 2–6) days). Cardiac magnetic resonance (CMR) was conducted within a week after infarction for determination of IS and MVO.ResultsMedian DETERMINE score of the overall cohort was 8 points (IQR 5–11). A higher DETERMINE score was significantly associated with a larger IS (21% vs 11% of left ventricular myocardial mass (LVMM), p<0.001) as well as larger MVO (1.2% vs 0.0% of LVMM, p<0.001). In linear and binary multivariable logistic regression analysis, the DETERMINE score remained independently associated with IS (OR 1.09, 95% CI 1.02 to 1.17, p=0.014) and MVO (OR 1.12, 95% CI 1.04 to 1.21, p=0.003), after adjustment for Selvester score and clinical indicators of IS (high-sensitivity cardiac troponin T, high-sensitivity C reactive protein, N-terminal pro-B-type natriuretic peptide, TIMI flow pre-interventional and post-interventional PCI, anterior infarct localisation).ConclusionsIn patients undergoing PCI for STEMI, the DETERMINE score provides an easy and inexpensive tool for appropriate estimation of infarct severity as determined by CMR.

Assessment of a New Electrocardiographic Marker for the Diagnosis of Myocardial Infarction With Non-obstructive Coronary Arteries

“…Lee et al 7 reported that the DETERMINE score estimated infarct size nearly as well as the left ventricular EF (LVEF) measured by CMR. In another study, Tiller et al 15 found a significant positive correlation between the DETERMINE score and MI in patients with STEMI. In our study, a DETERMINE score cut-off of ≤3 had good sensitivity (80.0%) and specificity (74.4%) for predicting MINOCA.…”

“…Lee et al 7 reported that the DETERMINE score estimated infarct size nearly as well as the left ventricular EF (LVEF) measured by CMR. In another study, Tiller et al 15 Currently, the diagnostic process of MINOCA may require multiple diagnostic steps such as echocardiography, left ventriculography, intracoronary imaging, computed tomography, pulmonary angiography, and CMR. Since there are no practical algorithms for MINOCA, diagnostic tools should be selected according to the suspected etiology.…”

Trajectories of Cardiac Function Following Treatment With an Impella Device in Patients With Acute Anterior ST-Elevation Myocardial Infarction

“…Anterior STEMI is commonly complicated by hemodynamic deterioration and cardiogenic shock, which in turn carry a high mortality risk. 15 , 16 , 17 A major contributor to morbidity and mortality following an anterior STEMI is adverse cardiac remodelling. 18 The use of the Impella device in selected anterior STEMI patients with shock presentation may improve short-term outcomes, but whether it has a beneficial long-term impact on cardiac remodelling remains unclear.…”

“…With respect to infarct localization, anterior localization seems to be associated with a greater extent of microvascular obstruction and a larger infarct size, which results in a higher incidence of heart failure and adverse events (eg, arrhythmias, secondary mitral regurgitation). 15 , 16 , 17 As a result, we decided to analyze the impact of an Impella device in a selected cohort of patients with anterior localization only, excluding patients with nonanterior infarction.…”

Using the DETERMINE Score in the Acute Setting of MINOCA or NSTEMI: Timing Is Important

“…An ECG was performed before discharge [median: 4 (interquartile range: 2-6) days]. 3 Some scores could be applied in acute or chronic settings; however, a major concern for the present study 1 is the timing of the ECG. The authors 1 reported that an ECG was obtained upon admission.…”