Peri-procedural ST segment resolution during Primary Percutaneous Coronary Intervention (PPCI) for acute myocardial
Grigoris V Karamasis1, Paul Russhard2, Firas Al Janabi1
1Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK.
Insights
Intra-procedural ST segment resolution (STR) during periprocedural primary percutaneous coronary intervention (PPCI) in STEMI patients was achieved in less than half of cases. Good STR was linked to better outcomes, including shorter hospital stays and improved ejection fraction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST segment resolution (STR) assesses myocardial perfusion in STEMI patients post-PPCI.
- Previous studies often used ECGs recorded after the catheterization lab, limiting timely interventions.
- Intra-procedural STR assessment is crucial for immediate therapeutic adjustments.
Purpose of the Study:
- To investigate the occurrence of intra-procedural ST segment resolution (STR) during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI).
- To evaluate the clinical consequences of achieving good STR within the catheterization laboratory.
Main Methods:
- Analysis of 12-lead ECGs recorded at the onset and end of PPCI in 467 STEMI patients.
- STR measured in the lead with maximal ST elevation, with "good" defined as >50% resolution.
- Correlation of STR with patient demographics, infarct location, and procedural characteristics.
Main Results:
- Good peri-procedural STR was observed in 46.5% of patients.
- Good STR was more frequent in inferior infarcts, current smokers, and those with symptom onset < 4 hours.
- Patients with good STR had higher rates of thrombus aspiration, shorter hospital stays, and improved LVEF.
Conclusions:
- Less than half of STEMI patients achieved good peri-procedural STR during PPCI.
- Good STR is associated with significant positive clinical outcomes.
- Identifying suboptimal STR intra-procedurally may guide new microcirculation-protective therapies.
Objective:
ECG ST segment resolution (STR) has been used to assess myocardial perfusion in STEMI patients undergoing PPCI. However, in most of the studies ECGs recorded at different time points after the actual procedure have been used, limiting the options of therapeutic interventions while the patient is still in the catheterisation laboratory. The aim of this study was to investigate the presence and clinical consequences of intra-procedural STR during PPCI.
Methods:
We analysed 12 lead ECGs recorded at the onset and the end of the PPCI procedure, measuring STR in the lead with maximum ST elevation on the initial recording. STR was defined as good when > 50% compared to baseline.
Results:
Pre and immediately post PPCI ECGs were recorded in 467 STEMI cases whilst the patient was on the catheter lab table. Mean patient age was 63 (+/- 12) years old and 75% were men. Mean duration of symptoms to admission was 3.8 (+/- 3.4) hours and 51% of infarcts were anterior. Good ST resolution at the end of the procedure was seen in 46.5% of patients and was observed more commonly in inferior compared to anterior infarcts (60.1% vs. 32.6%, p<0.001), and in current smokers (53.2% vs. 42.4%, p=0.031). In patients presenting with symptoms for < 4 hours, good STR was more common (74% vs. 66%, p=0.019). Thrombus aspiration was used more frequently in patients who had good STR (88.5% vs 79.8% p=0.011). Patients with good ST resolution had a shorter mean hospital length of stay (3.8 vs. 4.5 days, p=0.009) and a higher left ventricular ejection fraction (49.9% vs. 44.2%, p<0.001) measured by transthoracic echocardiography prior to discharge.
Conclusion:
Good peri-procedural ST resolution was seen in less than half of STEMI patients undergoing PPCI. There were important clinical consequences of good ST resolution. Identification of suboptimal peri-procedural ST resolution could help identify patients who may benefit from new treatments aimed at protecting the microcirculation, whilst the patients are still in the angiography laboratory.
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