Prognostic implications of ST-segment elevation resolution in patients with ST-segment elevation acute myocardial
Tullio Palmerini1, Stefano De Servi, Alessandro Politi
1Istituto di Cardiologia, Policlinico S. Orsola, Università di Bologna, Bologna, Italy.
Insights
ST-segment elevation resolution is a strong predictor of 30-day mortality in acute myocardial infarction patients treated with percutaneous coronary intervention. This finding holds true across various clinical risk profiles and postprocedural flow.
Area of Science:
- Cardiology
- Clinical Practice
- Interventional Cardiology
Background:
- Limited data exist on ST-segment elevation (STE) resolution's impact on 30-day mortality in contemporary acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI).
- The influence of patient risk profiles and Thrombolysis In Myocardial Infarction (TIMI) flow on the prognostic value of STE resolution remains unexplored.
Purpose of the Study:
- To investigate the association between STE resolution and 30-day mortality in a real-world setting.
- To determine if patient clinical risk or postprocedural TIMI flow modifies the prognostic significance of STE resolution.
Main Methods:
- Analysis of the Lombardima observational registry, prospectively collecting data from 3,403 patients with STE-acute myocardial infarction undergoing PCI.
- Stratification of patients based on clinical risk and assessment of STE resolution and 30-day mortality.
Main Results:
- ST-segment elevation resolution was observed in 2,452 patients (72%), with a significantly lower 30-day mortality rate (2.4%) compared to those without resolution (11.3%, p <0.001).
- STE resolution independently predicted lower 30-day mortality across all clinical risk strata.
- Even in patients with TIMI 3 flow, STE resolution remained a significant independent predictor of 30-day mortality (p <0.0001).
Conclusions:
- ST-segment elevation resolution is a powerful and independent predictor of 30-day mortality in patients with STE-acute myocardial infarction treated with PCI.
- This prognostic value is consistent across the spectrum of clinical risk and in patients achieving TIMI 3 flow.
Abstract:
Scant data are available on the relation between ST-segment elevation (STE) resolution and 30-day mortality in patients with STE acute myocardial infarction treated with percutaneous coronary intervention in contemporary, real world, clinical practice. Furthermore, whether the prognostic value of STE resolution is influenced by the patient clinical risk profile or postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow has never been investigated. Lombardima was an observational registry implemented in Lombardy, a Northern Italian region. The clinical characteristics, electorcardiographic parameters, and procedural data were prospectively entered into a Web-based database. In the present study, we enrolled 3,403 patients. STE resolution occurred in 2,452 patients (group 1) and did not in 951 patients (group 2). The mortality rate was 2.4% in group 1 and 11.3% in group 2 (p <0.001). After stratifying patients according to their TIMI risk index, we observed that STE resolution was an independent predictor of 30-day mortality across all spectrum of clinical risk. Furthermore, in patients with TIMI 3 flow, STE resolution remained an independent predictor of 30-day mortality (p <0.0001). In conclusion, STE resolution was a strong and independent predictor of 30-day mortality in patients with STE acute myocardial infarction undergoing percutaneous coronary intervention across all spectrum of clinical risk.
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