The extent of ST elevation and ST deviation as predictors of mortality in ST-segment elevation myocardial patients
S Postma1, J H E Dambrink2, A T M Gosselink2
1Diagram B.V. Zwolle, The Netherlands.
Insights
The extent of ST depression, not just ST elevation, significantly predicts 30-day and long-term mortality in ST-elevation myocardial infarction (STEMI) patients. Incorporating ST deviation improves electrocardiogram prognostic value.
Area of Science:
- Cardiology
- Electrocardiography
- Clinical Prediction Models
Background:
- Limited data exist on the prognostic value of ST deviation (elevation and depression).
- ST deviation assessment is crucial for predicting outcomes in ST-elevation myocardial infarction (STEMI).
Purpose of the Study:
- To evaluate the predictive value of ST elevation and ST deviation on 30-day and long-term mortality in STEMI patients.
- To determine if incorporating ST depression improves electrocardiogram (ECG) prognostic capabilities.
Main Methods:
- A prospective cohort study of 4513 STEMI patients undergoing primary percutaneous coronary intervention (pPCI) between 2001-2009.
- Patients were stratified into tertiles based on cumulative ST deviation and ST elevation, assessed by an independent core-lab.
- Cox proportional hazard models were used for multivariable adjustment.
Main Results:
- 30-day mortality increased with cumulative ST deviation (P=0.001) but not significantly with ST elevation.
- Long-term mortality increased with both cumulative ST deviation (P<0.001) and ST elevation (P=0.070).
- Multivariable analysis confirmed independent associations of ST deviation with 30-day mortality and both ST deviation and ST elevation with long-term mortality.
Conclusions:
- The extent of ST depression, in addition to ST elevation, enhances the predictive value of the 12-lead ECG.
- This improved prediction is particularly relevant for 30-day mortality in STEMI patients undergoing pPCI.
Background:
Only few data are available on the predictive value of ST deviation (both ST elevation and depression). Therefore, we have examined the predictive value of ST elevation and ST deviation in STEMI patients on 30-day and long term mortality.
Methods:
All STEMI patients with an interpretable diagnostic electrocardiogram, who were referred to the Isala hospital and were planned to undergo a primary coronary intervention (pPCI) in the period 2001 until 2009, were prospectively registered in a cohort study. These patients were divided in tertiles based on the cumulative (cum) ST deviation (D1, D2 and D3) and cum ST elevation (E1, E2 and E3), as assessed by an independent core-lab.
Results:
In total, 4513 patients were registered. 30-day mortality increased with cum ST deviation (0-9 mm: 1.9%, > 9-16 mm: 2.4%, > 16 mm: 3.9%, P = 0.001), but not significant with cum ST elevation. Long term mortality increased with cum ST-deviation (0-9 mm: 18.6%, > 9-16 mm: 22.1%, > 16 mm: 25.7%, P < 0.001) and with cum ST-elevation (0-6mm: 19.7%, > 6-11 mm: 22.7%, > 11 mm: 24.2%, P = 0.070). After multivariable adjustment using Cox proportional Hazard models, cum ST deviation (D1: reference, D2: HR: 1.09 95% CI (0.67-1.77), D3: HR: 1.76 95% CI (1.14-2.73)) was independently associated with 30-day mortality. Both cum ST deviation (D1: reference, D2: HR: 1.14 95% CI (0.98-1.34), D3: HR: 1.32 95% CI (1.13-1.53)) and ST elevation (E1: reference, E2: HR: 1.17 95% CI (1.00-1.38), E3: HR: 1.21 95% CI (1.04-1.42)) were independently associated with long term mortality.
Conclusions:
Besides ST elevation, taking the extent of ST depression into account improves the predictive value of the diagnostic 12 lead electrocardiogram especially for 30-day mortality in STEMI patients who are planned to undergo pPCI.
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