ST peak during percutaneous coronary intervention serves as an early prognostic predictor in patients with ST-segment
Jacob Lønborg1, Henning Kelbæk, Thomas Engstrøm
1Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Insights
The ST peak phenomenon during primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) predicts adverse long-term outcomes, including mortality and heart failure admissions. This finding offers crucial prognostic information beyond ST resolution and epicardial flow.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion.
- Percutaneous coronary intervention (PCI) is the primary treatment for STEMI.
- The prognostic significance of ST peak during primary PCI remains under investigation.
Purpose of the Study:
- To assess the clinical importance of the ST peak phenomenon in STEMI patients undergoing primary PCI.
- To determine if ST peak provides independent prognostic value.
Main Methods:
- Continuous ST monitoring in 942 STEMI patients during and after primary PCI.
- Definition of ST peak as ≥1 mm ST-segment increase during PCI.
- Median follow-up of 4.1 years to assess major adverse cardiac events (MACE).
Main Results:
- ST peak occurred in 26.9% of patients.
- ST peak was associated with higher rates of mortality, heart failure admissions, and MACE.
- Adjusted analyses confirmed ST peak as a significant predictor of MACE (HR 1.40-1.41).
Conclusions:
- ST peak during primary PCI is a strong predictor of adverse long-term outcomes in STEMI patients.
- The ST peak phenomenon offers independent prognostic information beyond ST resolution and epicardial flow.
Aims:
To evaluate the clinical importance of the ST peak phenomenon during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Methods And Results:
Continuous ST monitoring was performed in 942 STEMI patients from arrival until 90 minutes after revascularisation. ST peak was defined as ≥1 mm increase in the ST-segment during PCI compared with the ST elevation before intervention. ST peak was observed in 26.9% of patients. During median follow-up of 4.1 years, 20.7% of patients experienced a major adverse cardiac event (MACE). ST peak was associated with higher rates of mortality (13.4% versus 9.3%; p=0.044), admission for heart failure (10.6% versus 5.2%; p=0.002) and MACE (26.9% versus 18.2%; p=0.002), but not reinfarction (7.1% versus 5.2%; p=0.14). In two different Cox regression analyses, adjusting for predictors of MACE and ST peak including ST resolution and epicardial flow, ST peak remained significantly associated with MACE: adjusted hazard ratio (HR) 1.40 (95% confidence interval [CI] 1.01-1.95) and 1.41 (95% CI: 1.02-1.96).
Conclusions:
In the largest study hitherto evaluating the ST peak phenomenon during primary PCI, we demonstrated that ST peak is a strong predictor of adverse long-term outcome and provides independent prognostic information beyond that provided by ST resolution and epicardial flow.
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