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

Author:

Buller Christopher E.1,Fu Yuling1,Mahaffey Kenneth W.1,Todaro Thomas G.1,Adams Peter1,Westerhout Cynthia M.1,White Harvey D.1,van 't Hof Arnoud W.J.1,Van de Werf Frans J.1,Wagner Galen S.1,Granger Christopher B.1,Armstrong Paul W.1

Affiliation:

1. From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital...

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 <1 mm]: 1 to <2 mm, 1.23 [95% CI 0.74 to 2.03]; ≥2 mm, 2.22 [95% CI 1.35 to 3.65], corrected c-index=0.832; 90-day death/congestive heart failure/shock [reference <1 mm]: 1 to <2 mm, 1.55 [95% CI 1.06 to 2.26]; ≥2 mm, 2.33 [95% CI 1.59 to 3.41], corrected c-index=0.802). Biomarker estimates of infarct size declined in association with enhanced ST-segment recovery. Conclusions— An ECG performed early after primary PCI is a simple, widely available, inexpensive, and powerful prognostic tool applicable to patients with ST-elevation myocardial infarction.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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