[Single lead ST-segment resolution in acute ST-elevation myocardial infarction after primary percutaneous coronary
Da-peng Zhang1, Xin-chun Yang, Le-feng Wang
1Heart Center, Beijing Chaoyang Hospital, Institute of Cardiovascular Diseases, Capital University of Medical Science, Beijing 100020, China.
Insights
ST resolution (STR) on a single ECG lead after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is a valuable prognostic tool. Lack of STR predicts higher major adverse cardiac events (MACE) risk post-PCI.
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Interventional Cardiology
Context:
- ST-elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
- Primary percutaneous coronary intervention (PCI) is the standard treatment for STEMI.
- Early assessment of treatment efficacy and patient prognosis is crucial after PCI.
Purpose:
- To assess the prognostic significance of ST resolution (STR) measured from a single electrocardiogram (ECG) lead shortly after primary PCI in STEMI patients.
- To identify factors associated with inadequate STR.
- To determine if STR can predict major adverse cardiac events (MACE).
Summary:
- This retrospective study analyzed 964 STEMI patients undergoing primary PCI.
- ST resolution (STR) was assessed in a single ECG lead post-PCI.
- Non-STR was observed in approximately one-third of patients and was linked to older age, anterior MI, cardiac dysfunction, diabetes, and significantly higher MACE rates (25.5% vs. 4.4%).
- Non-STR independently predicted in-hospital MACE (HR=3.33) and was associated with anterior MI, longer pain-to-balloon time, cardiac dysfunction, and elevated WBC count.
Impact:
- STR is an accessible and potent prognostic marker for MACE following primary PCI in STEMI.
- STR can effectively stratify STEMI patients into low- and high-risk groups post-PCI.
- This finding aids in optimizing patient management and risk stratification strategies after STEMI treatment.
Objective:
To evaluate the prognostic value of ST resolution (STR) measured in a single ECG lead obtained early after primary PCI in patients with ST-elevation myocardial infarction (STEMI).
Methods:
In this retrospective study, STR, MACE and factors contributed to STR were analyzed in 964 patients underwent primary PCI post STEMI. The ECGs analysis was made by technicians blinded to the clinical data. MACE was compared between the STR (n = 662) and the non-STR (n = 302) groups. Factors associated with non-STR were analyzed by logistic regression method.
Results:
Although TIMI grade III flow was achieved after PCI, non-STR was shown in nearly 1/3 patients and these patients were older, dominant with anterior myocardial infarction, cardiac dysfunction, diabetes and was associated with a higher MACE ratio (25.5% vs. 4.4%, P < 0.001). Cox regression showed that non-STR was one of the independent predictors of in-hospital MACE (RR = 3.33, P < 0.001). Logistic regression showed that anterior myocardial infarction, the pain to balloon time, cardiac dysfunction and white blood cell count on admission were predictive factors of non-STR.
Conclusions:
STR obtained in a single ECG lead is an easy and important prognosticator of MACE post PCI in patients with STEMI. It could therefore be used to identify low- and high-risk STEMI patients post primary PCI.
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