Prognostic Implications of ST-Segment Elevation Resolution in Patients With ST-Segment Elevation Acute Myocardial Infarction Treated With Primary or Facilitated Percutaneous Coronary Intervention

Palmerini, Tullio; Servi, Stefano De; Politi, Alessandro; Martinoni, Alessandro; Musumeci, Giuseppe; Ettori, Federica; Piccaluga, Emanuela; Sangiorgi, Diego; Lauria, Giulia; Repetto, Alessandra; Castiglioni, Battistina; Fabbiocchi, Franco; Onofri, M; Cesare, Nicoletta De; D’Urbano, Maurizio; Poletti, Fabrizio; Sangiorgi, Giuseppe; Zanini, Roberto; Belli, Guido; Pirelli, Salvatore; Klugmann, Silvio

doi:10.1016/j.amjcard.2009.10.037

Cited by 16 publications

(14 citation statements)

References 10 publications

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“…ST-segment resolution after PCI was quantified as the percentage of the value obtained from the basal ECG, and was considered significant when a N 50% reduction of the initial value was observed 60 min after PCI [13,14].…”

Section: Methodsmentioning

confidence: 99%

Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: A comparison among different scoring systems and clinical definitions

Martinoni¹,

Servi

Politi

et al. 2012

International Journal of Cardiology

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Section: Methodsmentioning

confidence: 99%

Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: A comparison among different scoring systems and clinical definitions

Martinoni¹,

Servi

Politi

et al. 2012

International Journal of Cardiology

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“…15 In contrast, the DANAMI-2 investigators compared the long-term prognostic value of STR in 1421 patients treated with fibrinolysis compared with primary PCI, finding that STR at 90 minutes was an important predictor of short-and long-term (4.2 years) mortality after fibrinolysis but not after PCI. 4 Whether the differences between this and previous studies relate to patient selection, ECG analysis methodology, or the examination of outcomes at an early versus late time point is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between ST-Segment Recovery and Clinical Outcomes After Primary Percutaneous Coronary Intervention

Farkouh

Reiffel

Dressler

et al. 2013

Circ: Cardiovascular Interventions

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(PCI) leads to more rapid and sustained infarct-related artery patency, and has become widely accepted as the optimal reperfusion modality in STEMI. It has also been suggested that STR may be inversely related to infarct size, and can be used to compare the relative efficacy of different therapies at the time of PCI.3 In this regard, STR has the advantage of being noninvasive, inexpensive, and is easy to apply widely. 4 Few studies, however, have examined the impact of STR after PCI on late survival.Background-In patients with ST-segment elevation myocardial infarction undergoing thrombolytic therapy, the degree of ST-segment resolution (STR) correlates with long-term cardiovascular mortality. The long-term predictive value of STR after primary percutaneous coronary intervention (PCI) is less well understood. We sought to determine the long-term prognostic value of STR after primary PCI in ST-segment-elevation myocardial infarction. Methods and Results-In a formal substudy from the Harmonizing Outcomes with Revascularization and Stents inAcute Myocardial Infarction (HORIZONS-AMI) trial, 2484 patients with ST-segment-elevation myocardial infarction undergoing primary PCI with interpretable baseline and 60-minute post-PCI electrocardiograms had at least 1 mm of baseline ST-segment elevation in ≥2 contiguous leads. Patients were categorized by the degree of STR at 60 minutes:(1) complete (>70%); (2) partial (30%-70%); and (3) absent (<30%). Absent, incomplete, and complete STR were achieved in 514 (20.7%), 712 (28.7%), and 1258 (50.5%) patients, respectively. STR <30% was associated with a greater likelihood of hypertension, diabetes mellitus, longer symptom onset to balloon time, lower left ventricular ejection fraction, and final thrombolysis in myocardial infarction flow <3. At 3 years, patients with STR<30% experienced a higher rate of major adverse cardiovascular events (death, reinfarction, ischemia-driven target vessel revascularization or stroke; 29.9% versus 20.1% versus 19.6%; P<0.0001), ischemia-driven target vessel revascularization (20.4% versus 14.0% versus 11.7%; P<0.001), and mortality (8.4% versus 5.0% versus 5.6%; P=0.03) than those with partial and complete STR, respectively. By multivariable analysis, STR<30% was an independent predictor of 3-year major adverse cardiovascular events (hazard ratio, 1.58; 95% confidence interval, 1.24-2.00; P=0.0002) and 3-year ischemia-driven target vessel revascularization (hazard ratio, 1.87; 95% confidence interval, 1.41-2.48; P<0.0001). Conclusions-In this large international study, absent STR 60 minutes after primary PCI was present in ≈1 in 5 patients with ST-segment-elevation myocardial infarction and was a significant independent predictor of major adverse cardiovascular events and target vessel revascularization at 3 years. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966 (Circ Cardiovasc Interv. 2013;6:216-223.)

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“…ST peak remained independently associated with final infarct size when adjusting for known predictors for myocardial damage (Table 2, model 1), whereas ST peak was with a P value of .10, not significantly associated with LVEF(Table 2, model 2). Only looking at the patients treated with conventional PCI (placebo) and available CMR (n = 111), patients with ST peak (n = 35) developed significantly (P = .009) larger final infarct size (17; IQR, 9-20) than those without ST peak(11; IQR,(8)(9)(10)(11)(12)(13)(14). No interaction was observed between ST peak and treatment modality (P = .40 for interaction) in final infarct size.Follow-up data were available for all patients.…”

mentioning

confidence: 62%

“…3,4 The ST resolution is related to the extent of microvascular perfusion [5][6][7][8] and also toclinical outcome. [7][8][9][10][11][12][13] ST resolution is traditionally measured after the PCI procedure and may therefore be of limited clinical use. In contrast, the assessment of ST changes during reperfusion would potentially predict prognosis.…”

Section: Introductionmentioning

confidence: 99%

ST peak during primary percutaneous coronary intervention predicts final infarct size, left ventricular function, and clinical outcome

Lønborg¹,

Kelbæk²,

Holmvang³

et al. 2012

Journal of Electrocardiology

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Prognostic Implications of ST-Segment Elevation Resolution in Patients With ST-Segment Elevation Acute Myocardial Infarction Treated With Primary or Facilitated Percutaneous Coronary Intervention

Cited by 16 publications

References 10 publications

Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: A comparison among different scoring systems and clinical definitions

Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: A comparison among different scoring systems and clinical definitions

Relationship Between ST-Segment Recovery and Clinical Outcomes After Primary Percutaneous Coronary Intervention

ST peak during primary percutaneous coronary intervention predicts final infarct size, left ventricular function, and clinical outcome

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