ST peak during primary percutaneous coronary intervention predicts final infarct size, left ventricular function, and clinical outcome
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Updated: May 20, 2026
Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Jacob Lønborg1, Henning Kelbæk, Lene Holmvang
1Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. jacoblonborg@gmail.com
Insights
ST peak during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction indicates larger infarct size and worse heart function. This finding is linked to increased cardiac events and mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring immediate treatment.
- Primary percutaneous coronary intervention (PCI) is the standard reperfusion therapy for STEMI.
- A secondary increase in ST segment (ST peak) during reperfusion occurs in about one-third of STEMI patients post-PCI.
Purpose of the Study:
- To investigate the clinical significance of ST peak during primary PCI in STEMI patients.
- To determine the association between ST peak and infarct size, left ventricular ejection fraction (EF), and clinical outcomes.
Main Methods:
- A cohort of 363 STEMI patients undergoing primary PCI was studied.
- Patients were categorized based on the presence or absence of ST peak during reperfusion.
- Infarct size and EF were quantified using cardiovascular magnetic resonance (CMR).
Main Results:
- Patients with ST peak exhibited significantly larger final infarct size (14% vs. 10%, P = .003) and lower EF (53% vs. 57%, P = .022).
- Higher rates of cardiac mortality (8% vs. 3%, P = .047) and major adverse cardiac events (19% vs. 10%, P = .018) were observed in the ST peak group.
- Multivariable analysis confirmed ST peak as an independent predictor of adverse cardiac events (aHR, 2.03 [1.08-3.82]).
Conclusions:
- ST peak during primary PCI is a marker of significant myocardial injury.
- The presence of ST peak is associated with impaired left ventricular function and adverse clinical outcomes in STEMI patients.
- ST peak identifies patients at higher risk for cardiac events following primary PCI.
Background And Purpose:
One third of patients treated with primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction develop a secondary increase in electrocardiographic ST segment (ST peak) during reperfusion. The purpose was to determine the clinical importance of ST peak during primary PCI.
Methods:
A total of 363 patients with ST-elevation myocardial infarction were stratified to no ST peak or ST peak. Final infarct size and ejection fraction (EF) were assessed by cardiovascular magnetic resonance.
Results:
Patients with ST peak had a larger infarct size (14% vs 10%; P = .003) and lower EF (53% vs 57%; P = .022). Rates of cardiac mortality (8% vs 3%; P = .047) and cardiac events (cardiac mortality and admission for heart failure; 19% vs 10%; P = .018) were higher among patients with ST peak, but not all-cause mortality (8% vs 5%; P = .46). In a multivariable Cox regression analysis, ST peak remained significantly associated with cardiac events (adjusted hazard ratio, 2.03 [1.08-3.82]).
Conclusion:
ST peak during primary PCI is related to larger final infarct size, a reduced EF, and adverse cardiac clinical outcome.
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