The relationship between Gensini score and ST-segment resolution in patients with acute ST-segment elevation
Aycan Esen Zencirci, Ertugrul Zencirci1, Aleks Degirmencioglu
1Department of Cardiology, Acıbadem Maslak Hospital. aycanesen@hotmail.com.
Insights
The Gensini score (GS-pPCI) and high thrombus burden predict poor ST-segment resolution (STR) after primary percutaneous coronary intervention (pPCI) in ST-elevation myocardial infarction (STEMI) patients. These factors are key indicators of inadequate reperfusion post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Clinical outcomes in myocardial infarction (MI) depend on reperfusion success and atherosclerosis severity.
- Assessing coronary atherosclerosis severity is crucial for predicting MI patient outcomes.
Purpose of the Study:
- To evaluate the predictive capability of the Gensini score (GS-pPCI) for ST-segment resolution (STR) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI).
Main Methods:
- 114 STEMI patients undergoing pPCI were prospectively studied.
- Gensini score (GS-pPCI) and ST-segment elevation (STR) were assessed pre- and post-pPCI.
- Patients were categorized based on STR and infarct-related artery.
Main Results:
- Higher GS-pPCI and increased thrombus burden were associated with inadequate STR (STR < 50%).
- GS-pPCI showed an inverse correlation with STR (r = -0.287, p = 0.002).
- Multivariate analysis confirmed GS-pPCI and high thrombus burden as independent predictors of inadequate STR.
Conclusions:
- The Gensini score (GS-pPCI) and high thrombus burden are significant predictors of inadequate ST-segment resolution in STEMI patients treated with pPCI.
- These findings highlight the importance of assessing coronary atherosclerosis severity and thrombus burden for predicting reperfusion success.
Background:
Clinical outcomes of patients with myocardial infarction are primarily determined by the successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis.
Aim:
To investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI).
Methods:
The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimetres was obtained before angioplasty and 60 min after pPCI. ΣSTR < 50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading was calculated according to the results of coronary angiography, and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to STR: those with STR(-), and those with STR(+). Patients were also analysed according to the infarct-related artery.
Results:
GS-pPCI was significantly higher in patients with STR(-) (10.1 ± 11.8 vs. 22 ± 18.6, p = 0.005). GS-pPCI was inversely correlated with STR (r = -0.287, p = 0.002). In subgroup analysis, patients in the STR(-) group with culprit lesion in left anterior descending artery and left circumflex artery also showed higher GS-pPCI (10.9 ± 13.5 vs. 23.5 ± 21.3, p = 0.03 and 9.6 ± 8.7 vs. 24.1 ± 21, p = 0.04, respectively). High thrombus burden was also observed more frequently in patients with STR(-) (68% vs. 43%, p = 0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR 1.07, 95% CI 1.03-1.12, p = 0.001 and OR 3.28, 95% CI1.11-9.72, p = 0.03, respectively).
Conclusions:
GS-pPCI and high thrombus burden play an important role in predicting inadequate STR in patients with STEMI treated with pPCI.
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