The prognostic significance of single-lead ST-segment resolution in ST-segment elevation myocardial infarction
Marko Sirén1, Joonas Leivo2, Eero Anttonen3
1Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland.
Insights
Incomplete ST-segment resolution (STR) after myocardial infarction treatment indicates a higher risk of death or heart failure. Complete STR suggests a better prognosis for ST-elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- ST-segment elevation myocardial infarction (STEMI) presents significant global morbidity and mortality.
- ST-segment resolution (STR) is a simple electrocardiogram (ECG) tool for risk stratification post-primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the prognostic significance of STR in STEMI patients after primary PCI.
- To assess the association between incomplete STR and adverse cardiovascular outcomes at 1-year follow-up.
Main Methods:
- Analysis of 7,654 STEMI patients from the TOTAL trial.
- STR assessed 30-60 minutes post-primary PCI in the lead with maximal baseline ST-segment elevation.
- Primary outcome: composite of cardiovascular death, recurrent MI, cardiogenic shock, or NYHA class IV heart failure at 1 year.
Main Results:
- 42.9% of patients exhibited incomplete or no STR (<70%).
- The primary outcome occurred in 10.4% of the incomplete STR group versus 5.4% in the complete STR group.
- Incomplete STR ( < 70%) was associated with a 1.56-fold increased risk (adjusted HR 1.56; 95% CI 1.32-1.89; P < .001).
Conclusions:
- Incomplete STR (<70%) 30-60 minutes post-primary PCI is linked to worse 1-year outcomes in STEMI patients.
- This simple ECG finding warrants attention for risk assessment in STEMI management.
- STR serves as a valuable prognostic indicator following primary PCI in STEMI.
Background:
ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality worldwide. Simple electrocardiogram (ECG) tools, including ST-segment resolution (STR) have been developed to identify high-risk STEMI patients after primary percutaneous coronary intervention (PCI).
Subjects And Methods:
We evaluated the prognostic impact of STR in the ECG lead with maximal baseline ST-segment elevation (STE) 30-60 minutes after primary PCI in 7,654 STEMI patients included in the TOTAL trial. Incomplete or no STR was defined as < 70% STR and complete STR as ≥ 70% STR. The primary outcome was the composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or new or worsening New York Heart Association (NYHA) class IV heart failure at 1-year follow-up.
Results:
Of 7,654 patients, 42.9% had incomplete or no STR and 57.1% had complete STR. The primary outcome occurred in 341 patients (10.4%) in the incomplete or no STR group and in 234 patients (5.4%) in the complete STR group. In Cox regression analysis, adjusted hazard ratio for STR < 70% to predict the primary outcome was 1.56 (95% confidence interval 1.32-1.89; P < .001) (model adjusted for all baseline comorbidities, clinical status during hospitalization, angiographic findings, and procedural techniques).
Conclusion:
In a large international study of STEMI patients, STR < 70% 30-60 minutes post primary PCI in the ECG lead with the greatest STE at admission was associated with an increased rate of the composite of cardiovascular death, recurrent MI, cardiogenic shock, or new or worsening NYHA class IV heart failure at 1-year follow-up. Clinicians should pay attention to this simple ECG finding.
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