Predictors and outcome of grade 3 ischemia in patients with ST-segment elevation myocardial infarction undergoing
Sonja Postma1, Ton Heestermans, Jurrien W Ten Berg
1Diagram BV, Zwolle, The Netherlands.
Insights
Grade 3 ischemia, a marker of serious complications after myocardial infarction, is linked to high-risk patient factors. Identifying these patients early can improve outcomes and guide treatment strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrocardiography
Background:
- Grade 3 ischemia (G3I), characterized by QRS complex distortion, predicts severe complications post-acute myocardial infarction (AMI).
- Identifying patients prone to G3I is crucial for risk stratification and management strategies.
Purpose of the Study:
- To determine patient characteristics associated with the presence of Grade 3 ischemia (G3I) upon initial electrocardiogram in patients with AMI.
- To investigate the prognostic implications of G3I regarding reperfusion success and clinical outcomes.
Main Methods:
- Analysis of 1308 patients from the Ongoing Tirofiban In Myocardial infarction Evaluation trial 2, categorized by G2I or G3I based on enrollment ECG.
- Multivariate analysis to identify independent predictors of G3I and its association with post-percutaneous coronary intervention (PCI) outcomes and 30-day mortality.
Main Results:
- G3I was present in 32.6% of patients and associated with older age, male sex, diabetes, higher TIMI risk score, 3-vessel disease, anterior infarction, and higher Killip class.
- Patients with G3I had poorer ST-segment resolution post-PCI and a higher incidence of major adverse cardiac events.
- G3I independently predicted failed ST-segment resolution (OR 1.4) and 30-day mortality (OR 3.2).
Conclusions:
- G3I identifies a high-risk subgroup of AMI patients with specific clinical criteria.
- These patients exhibit suboptimal myocardial reperfusion and worse clinical outcomes, including increased mortality.
Purpose:
Grade 3 ischemia (G3I: distortion of the terminal portion of the QRS complex) is a predictor of serious complications after acute myocardial infarction. However, less is known about which patients are more prone to present with G3I.
Methods:
Patients who were enrolled in the Ongoing Tirofiban In Myocardial infarction Evaluation trial 2 were included. These patients were divided in 2 groups based on the enrolment electrocardiogram: grade 2 ischemia (G2I) or G3I.
Results:
Between June 2004 and November 2007, 1308 patients with interpretable electrocardiograms were enrolled. Grade 3 ischemia was found in 426 (32.6%) patients. Patients with G3I were older, more often male, more often had diabetes, had a Thrombolysis In Myocardial Infarction (TIMI) risk score of greater than 3, had 3 vessel disease, had an anterior infarction, more often presented in Killip class greater than 1, less often had a preprocedural TIMI 3 flow, and less often had a myocardial blush grade 3 post-PCI. One hour post-PCI, residual ST deviation was higher in patients with G3I compared with patients with G2I. Furthermore, G3I was associated with more major cardiac events (including death, myocardial infarction, urgent target vessel revascularization). After multivariate adjustment, G3I was an independent predictor of failure of ST-segment resolution 1 hour post-PCI (odds ratio, 1.4; 95% confidence interval, 1.1-1.9) and 30-day mortality (odds ratio, 3.2; 95% confidence interval, 1.2-8.7).
Conclusion:
Grade 3 ischemia was associated with high-risk patient criteria (older age, diabetes, TIMI risk score >3, Killip class >1, and anterior myocardial infarction) and represents a subgroup of high-risk patients who seems to be associated with poor myocardial reperfusion and worse outcome.
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