Time to Treatment Influences the Impact of ST-Segment Resolution on One-Year Prognosis

Author:

Fu Yuling1,Goodman Shaun1,Chang Wei-Ching1,Van de Werf Frans1,Granger Christopher B.1,Armstrong Paul W.1

Affiliation:

1. From the University of Alberta, Edmonton, Alberta, Canada (Y.F., W.-C.C., P.W.A.); the Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (S.G.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (F.V.d.W.); and Duke Clinical Research Institute, Durham, NC (C.B.G.).

Abstract

Background Early ST resolution after reperfusion is a prognostic indicator in acute myocardial infarction. Little information exists regarding the prognostic utility of ST resolution beyond 4 hours after fibrinolysis. Furthermore, the relation between time to treatment, ST resolution at 24 to 36 hours, and 1-year outcome has not been well studied. Accordingly, we undertook a prospective ECG substudy in the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) trial to examine this. Methods and Results Patients (n=13 100) were stratified into 3 ST-resolution categories, based on baseline and 24- to 36-hour ECGs: complete resolution (≥70%) in 6698 (51.1%) patients, partial resolution (30% to 70%) in 4610 (35.2%) patients, and no resolution (<30%) in 1792 (13.7%) patients; 1-year mortality rate was 5.1%, 8.0%, and 9.7%, respectively ( P <0.001). Among patients treated <2 hours after symptom onset, 55.6% had complete ST resolution, whereas 52.1% and 43% of patients treated between 2 to 4 hours and 4 to 6 hours, respectively, had complete ST resolution ( P <0.001). Within each category of ST resolution, patients treated <2 hours had lower 1-year mortality rates as compared with patients treated between 2 to 4 hours or >4 hours (3.8% versus 5.2% and 6.6%, P =0.002 in complete ST resolution; 5.7% versus 8.4% and 9.9%, P =0.001 in partial ST resolution; 7.1% versus 8.7% and 13%, P =0.006 in no resolution). The extent of ST resolution was closely and inversely correlated with 1-year mortality rates ( r =−0.963, P <0.001). Conclusions ST resolution at 24 to 36 hours after fibrinolysis is influenced by time to treatment and inversely related to 1-year mortality rates. Time to treatment further differentiates between high- and low-risk patients and further highlights the importance of reducing time delay to initiation of fibrinolysis in acute myocardial infarction.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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