Combined Assessments of Biochemical Markers and ST-Segment Resolution Provide Additional Prognostic Information for
Jong Shin Woo1, Jin Man Cho, Soo Joong Kim
1Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
Insights
Combining early biomarkers and ST-segment resolution significantly improves risk stratification for ST-elevation myocardial infarction (STEMI) patients. This dual assessment offers additive prognostic information for better patient outcomes.
Area of Science:
- Cardiology
- Biomedical Science
- Medical Diagnostics
Background:
- Prognostic value of biochemical markers and ST-segment resolution in myocardial infarction is known.
- The combined prognostic utility of these markers for risk stratification has not been evaluated.
Purpose of the Study:
- To evaluate the combined prognostic value of biochemical markers and ST-segment resolution in patients with ST-elevation myocardial infarction (STEMI).
- To assess if combining these factors improves early risk stratification.
Main Methods:
- 178 STEMI patients undergoing primary percutaneous coronary intervention were analyzed.
- Patients were grouped by ST-segment resolution: complete (≥70%), partial (30-70%), and incomplete (<30%).
- Multivariate analysis included demographic data, ECG, biomarkers, ejection fraction, and angiographic findings.
Main Results:
- Ejection fraction, high-sensitivity C-reactive protein, and ST-segment resolution were independent predictors of clinical outcomes.
- The addition of ST-segment resolution significantly enhanced the prognostic utility of a model with biochemical markers and ejection fraction.
- Cox-proportional hazards model demonstrated improved risk prediction with combined assessment.
Conclusions:
- Biomarker assessment and ST-segment resolution are strong predictors of clinical outcomes post-STEMI.
- Combining these assessments provides additive prognostic information early in disease progression.
- This combined approach further improves risk stratification for STEMI patients.
Background And Objectives:
The prognostic value of biochemical markers and the resolution of ST-segment elevation on electrocardiogram are well established. However, how a combination of these two tools affects the evaluation of risk stratification has not yet been evaluated.
Subjects And Methods:
Between January 2006 and June 2008, 178 consecutive patients treated with primary percutaneous coronary interventions after ST-segment elevation myocardial infarctions (STEMI) were analyzed at two coronary care units. Patients were divided into the following three groups according to ST-segment resolution: complete (≥70% depression of the elevated ST-segment, n=63), partial (30% to 70%, n=90), and incomplete (<30%, n=25). Demographic data, including history, electrocardiography, biochemical markers, initial ejection fraction, and angiographic findings were also evaluated.
Results:
There were 7 deaths, 3 repeated myocardial infarctions, and 17 readmissions for worsening heart failure during six months of follow-up. In a multivariate analysis to predict clinical outcomes, ejection fraction {hazard ratio (HR): 0.83 (0.76-0.91), p<0.01}, high-sensitivity C-reactive protein {HR: 1.15 (1.05-1.26), p<0.05}, and the degree of ST-segment resolution {HR: 0.96 (0.93-0.09), p<0.05} were independently associated with clinical outcomes. According to the Cox-proportional hazards model, the addition of ST-segment resolution markedly improved the prognostic utility of the model containing biochemical markers and ejection fraction.
Conclusion:
Assessment of biomarkers upon admission and ST-segment resolution are strong predictors of clinical outcomes. The combination of these data provides additive information about prognosis at an early point in the disease progression and further improves risk stratification for STEMI.
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