Early versus late ST-segment resolution and clinical outcomes after percutaneous coronary intervention for acute
H B van der Zwaan1, M G Stoel, J W Roos-Hesselink
1Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Insights
Assessing ST-segment resolution (STR) immediately after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) provides similar prognostic value as later assessments. Early or late STR indicates a lower risk of cardiac death but a higher risk of rehospitalization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Incomplete ST-segment resolution (STR) post-percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is linked to mortality.
- Traditional STR assessment occurs 60-90 minutes post-reperfusion therapy in the coronary care unit (CCU).
Purpose of the Study:
- To evaluate the prognostic significance of immediate STR after PCI in STEMI patients.
- To compare the prognostic value of early versus late STR with no STR.
Main Methods:
- Analysis of 223 STEMI patients with successful PCI.
- Continuous ECG monitoring during PCI and 30 minutes post-CCU arrival (mean 81 minutes post-reflow).
- Stratification into early STR, late STR, and no STR groups with one-year follow-up for major adverse cardiac events.
Main Results:
- Early STR observed in 52% and late STR in 19% of patients.
- Both early and late STR groups showed significantly lower one-year cardiac death rates compared to no STR (1.9% vs 9.2%, p=0.02).
- Rehospitalization rates were higher in early/late STR groups (20.3%) versus no STR (6.2%, p=0.009), with similar prognostic value for cardiac death.
Conclusions:
- The prognostic value of STR in STEMI patients does not significantly change within the 0-90 minute window post-PCI.
- Immediate STR assessment post-PCI holds comparable prognostic weight to later CCU assessments.
Abstract:
Background. Absence of complete ST-segment resolution (STR) after percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI) is a determinant of mortality. Traditionally, STR is determined on the coronary care unit (CCU) 60 to 90 minutes after the initiation of reperfusion therapy. We studied the prognostic value of STR immediately after PCI. Methods. We analysed 223 consecutive patients with STEMI and successful PCI. Continuous ECG data were collected during PCI and at 30 minutes after arrival on the CCU (mean time 81±17 minutes after reflow of the culprit artery). Patients were divided into three groups: patients with complete STR immediately after PCI ('early'), patients with complete and persistent STR at 30 minutes on the CCU, but not immediately after PCI ('late') and patients without STR. One-year follow-up was obtained for death and rehospitalisation for major adverse cardiac events. Cox proportional hazards regression was used to evaluate the association between STR and outcome. Results. Early STR occurred in 115 (52%) and late STR in 43 (19%) patients. Patients with early or late STR had a lower incidence of one-year cardiac death than those without STR (1.9 vs. 9.2%; p=0.02). In contrast, rehospitalisation occurred more frequently in patients with early or late STR (20.3 vs. 6.2%; p=0.009). As compared with patients without STR, early and late STR had a similar prognostic value (hazard ratios [95% confidence interval] for cardiac death 0.40 [0.08-2.03] and 0.25 [0.03-2.08]).Conclusions. We found no (major) change in prognostic value of STR during the 0 to 90 minutes time window after PCI. (Neth Heart J 2010;18:416-22.).
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