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ST segment resolution post MI--a predictor of better outcomes
Shuja-ur-Rehman1, Sidrah Sheikh, Mohsin Nazeer
1Aga Khan University, Karachi.
Insights
Early ST segment resolution on ECG after thrombolysis for myocardial infarction indicates better in-patient outcomes. Patients showing ST resolution had significantly fewer complications like chest pain, heart failure, and arrhythmias.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Myocardial infarction (MI) is a leading cause of mortality globally.
- Early assessment of MI outcomes is crucial for patient management.
- Electrocardiogram (ECG) ST segment resolution is a marker of reperfusion after treatment.
Purpose of the Study:
- To compare in-hospital outcomes of ST-elevation myocardial infarction (STEMI) patients based on early ST segment resolution after thrombolysis.
- To evaluate the predictive value of ST resolution for major complications in a South Asian population.
Main Methods:
- Prospective study of 148 STEMI patients treated with streptokinase thrombolysis.
- Patients were divided into two groups: ST segment resolution (Group A) and no ST segment resolution (Group B) at 60 minutes post-thrombolysis.
- In-hospital complications including recurrent chest pain, heart failure, arrhythmias, and death were monitored.
Main Results:
- Group B (no ST resolution) had a significantly higher rate of complications (81%) compared to Group A (35%) (p<0.001).
- Recurrent chest pain (59% vs 20%), heart failure (62% vs 27%), and arrhythmias (32% vs 10%) were more frequent in Group B.
- ST segment resolution was strongly associated with a reduced risk of adverse in-hospital events.
Conclusions:
- Early ST segment resolution on ECG is a valuable predictor of favorable early clinical outcomes in post-MI patients.
- Thrombolytic therapy effectiveness can be assessed by ST segment monitoring.
- This finding is particularly relevant for guiding management in populations undergoing thrombolysis for MI.
Objective:
To compare, the post Myocardial Infarction in-patient outcome of patients with early ST resolution to those without ST resolution on ECG, in a South Asian population.
Methods:
This was a prospective study done at the Punjab Institute of Cardiology, Lahore. Consecutive patients of ST elevation myocardial infarction, who were not treated with primary angioplasty but were thrombolysed were recruited at the time of arrival in the emergency department. Streptokinase was administered to all patients as the agent of thrombolysis. ECG was acquired at baseline and at 60 minutes post streptokinase administration. Patients were subsequently divided into two groups (A) Patients with ST segment resolution, after 60 minutes of administration of streptokinase (B). Patients without ST segment resolution, after 60 minutes of administration of streptokinase. This cohort was followed up through the in hospital stay for major complications which were recurrent ischaemic chest pain ,heart failure, arrhythmias and death, during the follow up period (Mean stay 3.01+/- 0.77 days).
Results:
A total of 148 patients were included in this prospective study. There were 122 males and 26 females. In group A complications developed in 33 (35%) out of 95 patients and 43 (81%) out of 53 patients in group B (p< 0.001). Recurrent chest pain was present in 19 (20%) patients of group A and 31 (59%) patients of group B (p<0.001).Heart failure was the most common complication observed in both groups, 26 (27%) patients in group A and 33 (62%) patients in group B (p<0.001). Arrhythmias were more common in group B, with 17 (32%) patients from group B and 9 (10%) from group A developing this complication (p<0.001).
Conclusions:
The extent of ST segment resolution provides useful information about early clinical outcome in post-myocardial infarction patients.