Predicting 30-Day Mortality Using ST-Segment Elevation Resolution in ST-Elevation Myocardial Infarction Patients
Shankar Chandra Mandal1, Bhushan Shah2, Lokendra Rekwal2
1Department of Cardiology, Institute of Post Graduate Medical Education and Research, Kolkata, IND.
Insights
ST-segment elevation (STE) resolution after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) predicts 30-day mortality in Indian patients. Persistent STE indicates higher mortality risk, guiding further interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Background:
- Limited data exists on ST-segment elevation (STE) resolution and 30-day mortality in non-Indian populations post-primary percutaneous coronary intervention (pPCI).
- This study focuses on evaluating the prognostic value of STE resolution in Indian patients with ST-elevation myocardial infarction (STEMI) undergoing pPCI.
Purpose of the Study:
- To assess the predictive capability of STE resolution for 30-day mortality in Indian STEMI patients treated with pPCI.
- To investigate the correlation between the extent of STE resolution and major adverse cardiovascular events (MACE) at 30 days.
Main Methods:
- A prospective, single-center, observational study involving 56 Indian patients with STEMI undergoing pPCI.
- Patients were categorized by STE resolution: complete (≥70%), partial (30-70%), and none (<30%).
- Primary endpoint included all-cause death, reinfarction, stroke, and target vessel revascularization within 30 days.
Main Results:
- Mortality rates were 2.1% for partial and 33.3% for no STE resolution; no deaths occurred with complete resolution.
- Significant differences in 30-day survival were observed across the three STE resolution groups (P<0.01).
- STE resolution independently predicted 30-day mortality, even in patients with post-PCI TIMI 3 flow.
Conclusions:
- Persistent STE after pPCI is a reliable predictor of 30-day mortality in Indian STEMI patients.
- The degree of STE resolution serves as a cost-effective tool for early mortality risk stratification.
- Patients with persistent STE require focused interventions due to their elevated 30-day mortality risk.
Background:
The relationship between ST-segment elevation (STE) resolution and 30-day mortality has been evaluated, although limitedly, in non-Indian patients undergoing primary percutaneous coronary intervention (pPCI). We aimed to evaluate the prognostic utility of STE resolution in predicting 30-day mortality in Indian patients undergoing pPCI for ST-elevation myocardial infarction (STEMI).
Materials And Methods:
This prospective, single-center, observational study investigated the correlation between 30-day mortality rate and extent of STE resolution in real-world Indian patients undergoing pPCI for STEMI. A total of 64 patients underwent pPCI for STEMI at a tertiary care center in India. The patients were classified into three groups based on the extent of STE resolution: complete resolution (≥70%), partial resolution (30-70%), and no resolution (<30%). The primary endpoint of the study was occurrence of major adverse cardiovascular events consisting of all-cause death, reinfarction, disabling stroke, and ischemia-induced target vessel revascularization at 30 days follow-up.
Results:
The study enrolled 56 patients. The mean age of patients was 59.7±6.8 years and there were 46 (82.1%) males. Complete STE resolution (≥70%) occurred in 7.1%, partial resolution (<70-30%) in 82.1% and no resolution (<30%) in 10.7%. The mortality rate was 2.1% and 33.3% in patients with partial and no STE resolution. No mortality was seen in patients with complete STE resolution. The 30-day survival analysis revealed significant differences between the three groups (P<0.01). STE resolution served as an independent predictor of 30-day mortality across all clinical variables, including patients with post-PCI thrombolysis in myocardial infarction (TIMI) 3 flow.
Conclusions:
Persistent STE after PCI is a reliable indicator of 30-day mortality in real-world STEMI patients. The extent of STE resolution can be used as a simple and affordable tool to stratify patients by the risk of mortality soon after the acute event. Due to their higher mortality at 30 days follow-up, individuals with persistent STE should be the focus for further treatment interventions.
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