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Clinical Outcomes of ST-segment Resolution following Primary Percutaneous Coronary Intervention: A Retrospective,
Khaled M Shunnar1, Alaa Rahhal2, Mohamed Abdelghani1
1Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Insights
Persistent ST elevation (STE) after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) indicates higher risks for in-hospital mortality, heart failure, and cardiogenic shock.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- ST elevation (STE) resolution is key for successful thrombolysis in ST-elevation myocardial infarction (STEMI).
- The impact of persistent STE on outcomes after primary percutaneous coronary intervention (PPCI) remains unclear.
Purpose of the Study:
- To evaluate the association between persistent STE and in-hospital outcomes following PPCI in STEMI patients.
- To identify STE resolution as a potential predictor of adverse events.
Main Methods:
- Retrospective cohort analysis of 1250 STEMI patients undergoing PPCI (January 2016 - September 2018).
- Patients categorized by STE resolution: complete (>70% decrease), partial (30%-70% decrease), or persistent (<30% decrease/increase).
- Multivariate logistic regression analyzed in-hospital mortality, cardiogenic shock, heart failure, and readmission rates between resolved and persistent STE groups.
Main Results:
- Persistent STE was associated with significantly higher rates of clinical heart failure (aOR: 1.7), cardiogenic shock (aOR: 2.7), in-hospital mortality (aOR: 4.8), and heart failure readmission (aOR: 3.9).
- Patients with persistent STE had increased risks for all evaluated adverse in-hospital outcomes compared to those with resolved STE.
Conclusions:
- Persistent STE post-PPCI is a rapid clinical marker for adverse in-hospital outcomes and readmission in STEMI patients.
- Further research into interventions, like intensive medical therapy, is warranted to improve outcomes for patients with persistent STE.
Background:
Resolution of ST elevation (STE) is the hallmark of successful thrombolysis for ST-elevation myocardial infarction (STEMI). However, the effect of persistent STE on in-hospital outcomes following primary percutaneous coronary intervention (PPCI) is not well established.
Methods:
In this single-center retrospective cohort analysis, all patients admitted between January 1, 2016, and September 30, 2018, with a diagnosis of STEMI who underwent PPCI were included. Complete resolution was defined as a >70% decrease in the STE sum on the first electrocardiogram following PPCI. Partial resolution denoted a 30%-70% decrease, and persistent STE denoted a <30% decrease or any increase in the STE sum. The study population was divided into two groups: (1) resolved STE incorporating complete and partial resolution and (2) persistent STE incorporating persistent and increased STE. Using multivariate logistic regression, we compared the rates of in-hospital mortality, cardiogenic shock, intensive care unit admission, clinical heart failure, and readmission for a cardiac reason and heart failure between the study groups.
Results:
We included 1250 patients in the analysis. Most patients were male (96%) with a mean age of 52 ± 10 years. More than three-quarters were Asian. Compared with patients with resolved STE, patients with persistent STE had a higher risk of clinical heart failure (24% vs. 12%, adjusted odds ratio [aOR]: 1.7 [95% confidence interval (CI): 1.2-2.5], P = 0.003), cardiogenic shock (12.1% vs. 5.3%, aOR: 2.7 [95% CI: 1.73-4.24], P < 0.001), in-hospital mortality (5.1% vs. 2.1%, aOR: 4.8 [95% CI: 2.35-9.88], P < 0.001), and readmission for heart failure (6.9% vs. 1.6%, aOR: 3.9 [95% CI: 1.95-7.82], P < 0.001).
Conclusion:
Persistent STE following PPCI is a quick clinical indicator of in-hospital adverse outcomes and readmission. Future studies may explore interventions, such as early intensive medical therapy, that can improve outcomes in this population.
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