ST-Segment Recovery and Outcome After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

Abstract

Background-Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining prognosis after primary percutaneous coronary intervention (PCI) would facilitate appropriate care and expedite hospital discharge. Thus, we determined the prognostic importance of various measures of ST-segment-elevation recovery after primary PCI in a large, contemporary cohort of patients with ST-elevation myocardial infarction. Methods and Results-We analyzed ECG data describing the magnitude and extent of ST-segment elevation and deviation before and early after (ie, 30 minutes) primary PCI in the study cohort of 4866 subjects with electrocardiographically high-risk ST-elevation myocardial infarction enrolled in the Assessment of PEXelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Associations among 6 methods for calculating ST-segment recovery, biomarker estimates of infarct size (ie, peak creatine kinase, creatine kinase-MB, and troponin I and T), and prespecified clinical outcomes (ie, rates of 90-day death and 90-day death, heart failure, or shock) were examined. All ST-segment-recovery methods provided strong prognostic information regarding clinical outcomes. A simple ST-segment-recovery method of residual ST-segment elevation measurement in the most affected lead on the post-PCI ECG performed as well as complex methods that required comparison of pre-and post-PCI ECGs or calculation of summed ST-segment deviation in multiple leads (ie, worst-lead residual ST elevation: adjusted hazard ratio for 90-day death rate [reference Ͻ1

Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial

“…2 Both distal embolisation and reduced tissue perfusion (impaired ST segment resolution and angiographic myocardial blush grade) after primary PCI have been associated with substantial increases in mortality and morbidity. [2][3][4] Thrombus aspiration during primary PCI has been thought to be an effective method for reducing distal embolisation and improving microvascular perfusion. The Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS), 5 which enrolled 1071 patients, showed that routine thrombus aspiration improved the primary outcome of microvascular perfusion.…”

Rezolucija ST segmenta kao prognostički marker pojave ranih neželjenih kardiovaskularnih događaja poslije infarkta miokarda

“…To je u suprotnosti sa rezultatima CADILLAC studije koja je otkrila značajnu vezu između oporavka ST segmenta na elektrokardiogramu snimljenom 4 h od PCI i oba 30 dnevnog i jednogodišnjeg mortaliteta [9]. Takođe, u Assessment of the PEXilizumab in Acute Myocardial Infarction studiji (APEX-AMI) utvrđena je veza između ranog oporavka ST segmenta (prosječno 32 min poslije primarne PCI) i 90 dnevnog mortaliteta [20].…”

Early versus late ST-segment resolution and clinical outcomes after percutaneous coronary intervention for acute myocardial infarction

“…Complete STR was defined as >70% STR or <70% without residual ST-segment elevation (<1 mm in non-anterior leads and <2 mm in anterior leads), while no STR was defined as <70% STR with residual ST-segment elevation. 6 Patients were divided into three groups according to the presence or absence of STR: complete and persistent STR immediately after PCI, ('early'), complete and persistent STR at 30 minutes on the CCU, but not immediately after PCI ('late') and no or incomplete STR at 90 min after PCI ('without').…”

“…Absent or incomplete STR after PCI is a strong predictor for impaired left ventricular function and adverse clinical outcomes. [1][2][3][4][5][6][7][8] After fibrinolysis for STEMI, the electrocardiogram (ECG) for measuring STR is usually taken 60 to 90 minutes after onset of therapy. [9][10][11] After primary PCI, the first ECG that is suitable for evaluation of STR is usually done on the coronary care unit (CCU).…”

“…It ranges from the time of arrival on the CCU, approximately 30 minutes after PCI, to another 30 minutes or even several hours later. [1][2][3][4][5][6][7] Earlier studies showed that STR at 30 minutes after PCI correlated better with other markers of myocardial perfusion than STR at 60 to 90 minutes. 12,13 However, the optimal time to measure STR after primary PCI is unknown.…”