Estimating the extent of myocardial damage in patients with STEMI using the DETERMINE score
Christina Tiller1, Magdalena Holzknecht1, Martin Reindl1
1University Clinic of Internal Medicine III, Cardiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria.
Insights
The DETERMINE electrocardiogram (ECG) score effectively estimates myocardial infarct size and microvascular obstruction in ST-elevation myocardial infarction (STEMI) patients. This simple, inexpensive tool aids in assessing infarct severity post-percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Myocardial scar assessment is crucial in ischaemic cardiomyopathy.
- The DETERMINE score is a novel, simple electrocardiogram (ECG) score for myocardial scar estimation.
- Its utility in ST-elevation myocardial infarction (STEMI) requires further evaluation for infarct size (IS) and microvascular obstruction (MVO) assessment.
Purpose of the Study:
- To evaluate the DETERMINE score's effectiveness in assessing myocardial infarct size (IS) and microvascular obstruction (MVO) in STEMI patients.
- To compare the DETERMINE score with the established Selvester scoring system.
- To determine if the DETERMINE score is an independent predictor of IS and MVO.
Main Methods:
- An observational study included 423 STEMI patients treated with primary percutaneous coronary intervention (PCI).
- Electrocardiograms (ECGs) were performed before discharge to calculate DETERMINE and Selvester scores.
- Cardiac magnetic resonance (CMR) imaging was used within one week to quantify IS and MVO.
Main Results:
- A higher DETERMINE score correlated significantly with larger IS (21% vs 11% of left ventricular myocardial mass) and MVO (1.2% vs 0.0%).
- The DETERMINE score remained an independent predictor of IS (OR 1.09) and MVO (OR 1.12) after multivariable logistic regression.
- These associations persisted after adjusting for the Selvester score and other clinical indicators.
Conclusions:
- The DETERMINE score is a valuable, simple, and inexpensive tool for estimating infarct severity in STEMI patients undergoing PCI.
- Its accuracy is validated by Cardiac Magnetic Resonance (CMR) findings.
- This ECG-based score aids in appropriate assessment of infarct severity.
Background:
Recently, a simple ECG score (DETERMINE score) has been proposed for estimating myocardial scar in patients with ischaemic cardiomyopathy. We sought to evaluate the usefulness of the DETERMINE score for the assessment of myocardial infarct size (IS) as well as microvascular obstruction (MVO), in the setting of ST-elevation myocardial infarction (STEMI).
Methods:
This observational study enrolled 423 patients with STEMI (median age 56, 17% women), revascularised by primary percutaneous coronary intervention (PCI). For evaluation of the DETERMINE and Selvester scoring system (an established but complex ECG score for IS estimation), ECG was conducted before discharge (median: 4 (IQR 2-6) days). Cardiac magnetic resonance (CMR) was conducted within a week after infarction for determination of IS and MVO.
Results:
Median DETERMINE score of the overall cohort was 8 points (IQR 5-11). A higher DETERMINE score was significantly associated with a larger IS (21% vs 11% of left ventricular myocardial mass (LVMM), p<0.001) as well as larger MVO (1.2% vs 0.0% of LVMM, p<0.001). In linear and binary multivariable logistic regression analysis, the DETERMINE score remained independently associated with IS (OR 1.09, 95% CI 1.02 to 1.17, p=0.014) and MVO (OR 1.12, 95% CI 1.04 to 1.21, p=0.003), after adjustment for Selvester score and clinical indicators of IS (high-sensitivity cardiac troponin T, high-sensitivity C reactive protein, N-terminal pro-B-type natriuretic peptide, TIMI flow pre-interventional and post-interventional PCI, anterior infarct localisation).
Conclusions:
In patients undergoing PCI for STEMI, the DETERMINE score provides an easy and inexpensive tool for appropriate estimation of infarct severity as determined by CMR.
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