Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention
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Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention. / Lønborg, Jacob; Kelbæk, Henning; Holmvang, Lene; Helqvist, Steffen; Vejlstrup, Niels; Jørgensen, Erik; Saunamäki, Kari; Dridi, Nadia P; Kløvgaard, Lene; Kaltoft, Anne; Bøtker, Hans-Erik; Lassen, Jens F; Clemmensen, Peter; Terkelsen, Christian Juhl; Engstrøm, Thomas.
in: AM J CARDIOL, Jahrgang 117, Nr. 11, 01.06.2016, S. 1735-1740.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention
AU - Lønborg, Jacob
AU - Kelbæk, Henning
AU - Holmvang, Lene
AU - Helqvist, Steffen
AU - Vejlstrup, Niels
AU - Jørgensen, Erik
AU - Saunamäki, Kari
AU - Dridi, Nadia P
AU - Kløvgaard, Lene
AU - Kaltoft, Anne
AU - Bøtker, Hans-Erik
AU - Lassen, Jens F
AU - Clemmensen, Peter
AU - Terkelsen, Christian Juhl
AU - Engstrøm, Thomas
N1 - Copyright © 2016 Elsevier Inc. All rights reserved.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution.
AB - Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution.
KW - Coronary Angiography
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Magnetic Resonance Imaging, Cine
KW - Male
KW - Middle Aged
KW - Percutaneous Coronary Intervention/methods
KW - Prognosis
KW - Recovery of Function
KW - Retrospective Studies
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.amjcard.2016.03.009
DO - 10.1016/j.amjcard.2016.03.009
M3 - SCORING: Journal article
C2 - 27062938
VL - 117
SP - 1735
EP - 1740
JO - AM J CARDIOL
JF - AM J CARDIOL
SN - 0002-9149
IS - 11
ER -
