Electrocardiogram score for the selection of reperfusion strategy in early latecomers with ST-segment elevation
Yu-Jiao Zhang1, Wen Zheng1, Jian Sun1
1Department of Cardiology, the First Hospital of Jilin University, Changchun, China.
Insights
Percutaneous coronary intervention (PCI) benefits STEMI patients presenting late if they have a large myocardial area at risk (MaR ≥35%). For those with smaller MaR (<35%), optimal medical therapy alone is comparable to PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- The clinical utility of percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients presenting 12-72 hours after symptom onset remains debated.
- Previous studies suggest that the myocardial area at risk (MaR) may influence PCI outcomes in these latecomer STEMI patients.
Purpose of the Study:
- To investigate the association between myocardial area at risk (MaR) and the clinical benefit of PCI versus optimal medical therapy (OMT) in STEMI patients presenting 12-72 hours after symptom onset.
- To determine if PCI offers advantages over OMT in specific subgroups of late STEMI patients stratified by MaR.
Main Methods:
- A prospective cohort study included 436 STEMI patients presenting 12-72 hours after symptom onset.
- Patients were divided into two groups: 218 underwent PCI and 218 received OMT alone.
- Myocardial area at risk (MaR) was quantified using the Aldrich ST and Selvester QRS score. The primary endpoint was a composite of cardiovascular death, reinfarction, or revascularization within two years.
Main Results:
- In patients with MaR < 35%, the 2-year cumulative primary endpoint rate was 9.2% for PCI and 5.3% for OMT (adjusted hazard ratio [aHR] for PCI vs. OMT: 1.855; P=0.271).
- In patients with MaR ≥ 35%, the 2-year cumulative primary endpoint rate was 12.8% for PCI and 23.1% for OMT (aHR for PCI vs. OMT: 0.448; P=0.021).
Conclusions:
- The benefit of PCI in STEMI latecomers is significantly associated with the myocardial area at risk (MaR).
- PCI demonstrated a significant reduction in 2-year primary outcomes compared to OMT in patients with MaR ≥ 35%.
- PCI did not show a significant benefit over OMT in patients with MaR < 35%.
Objective:
The clinical benefit of percutaneous coronary intervention (PCI) is controversial in ST-segment elevation myocardial infarction (STEMI) patients presenting 12-72 hours after symptom onset. Several studies suggested this conflicting result was associated with myocardial area at risk (MaR) of enrolled patients. MaR could be estimated by the electrocardiogram (ECG) score. Our objective was to evaluate the benefits of PCI in STEMI latecomers with different MaR.
Methods:
We constructed a prospective cohort involving 436 patients presenting 12-72 hours after STEMI onset and who met an inclusion criteria. 218 underwent PCI and 218 received the optimal medical therapy (OMT) alone. Individual MaR was quantified by the combined Aldrich ST and Selvester QRS score. The primary endpoint was a composite of cardiovascular death, reinfarction or revascularization within two years.
Results:
The 2-year cumulative primary endpoint rate was respectively 9.2% in PCI group and 5.3% in OMT group when MaR<35% (adjusted hazard ratio for PCI vs. OMT, 1.855; 95% confidence interval [CI], 0.617-5.575; P=0.271), and was 12.8% in PCI group and 23.1% in OMT group when MaR ≥35% (adjusted hazard ratio for PCI vs. OMT, 0.448; 95% CI, 0.228-0.884; P=0.021).
Conclusion:
The benefit of PCI for the STEMI latecomers was associated with the MaR. PCI, compared with OMT, could significantly reduce the 2-year primary outcomes in patients with MaR≥35%, but not in ones with MaR<35%.
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