The relation between ST-segment resolution and in-hospital mortality after primary percutaneous coronary interventions
Abstract
Objective: The resolution of ST-segment elevation (>50%) indicates successful reperfusion with thrombolytic therapy. The aim of this study is to evaluate the relation of ST-segment resolution post-primary percutaneous cardiac intervention (PCI) with in-hospital mortality and coronary thrombolysis in myocardial infarction (TIMI) blood flow.
Methods: This study is a single-centred retrospective study. The study enrolled 100 patients who were referred to the Nasiriya Heart Centre for primary PCI. We measured the ST segment amplitude in the lead with the highest elevation prior to primary PCI and assessed the ST-segment elevation post-primary PCI. The ratio of ST-segment resolution was calculated and considered complete if reaches ≥70% from the initial ST-segment elevation. We assessed the association of ST-segment resolution with in-hospital mortality.
Results: Analysis of the electrocardiogram (ECG) showed that 21 patients (21%) had complete ST-segment (≥ 70%) resolution. No significant association was shown between ST-segment resolution and in-hospital mortality. Two out of 21 patients with complete ST-segment resolution died in the hospital and 6 out of 79 patients with incomplete ST-segment resolution died (P=0.77). There is no significant association between ST-segment resolution and coronary TIMI flow grades. In patients with complete ST-segment resolution, 19 patients had TIMI III flow and 2 patients had TIMI II flow. In patients with incomplete ST-segment resolution, 72 patients had TIMI III flow, 6 patients had TIMI II flow; and 1 patient had no-reflow (P=0.84).
Conclusion: Complete ST-segment resolution in post-primary PCI settings has no significant association with in-hospital mortality. Absent or incomplete ST-segment resolution is not necessarily an indicator of coronary artery re-occlusion after primary PCI.
Konijnenberg LSF, Damman P, Duncker DJ, et al. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovasc Res. 2020;116(4):787-805.
de Lemos J, Braunwald E, et al. ST segment resolution as a tool for assessing the efficacy of reperfusion therapy. J Am Coll Cardiol. 2001;38(5):1283-94.
McKendall GR, Forman S, Sopko G, Braunwald E, Williams DO. Value of rescue percutaneous transluminal coronary angioplasty following unsuccessful thrombolytic therapy in patients with acute myocardial infarction. Thrombolysis in myocardial infarction investigators. Am J Cardiol. 1995;76(16):1108-11.
Gibson CM, Cannon CP, Greene RM, et al. Rescue angioplasty in the thrombolysis in myocardial infarction (TIMI) 4 trial. Am J Cardiol. 1997;80(1):21-6.
de Lemos JA, Antman EM, Giugliano RP, et al. ST-segment resolution and infarct-related artery patency and flow after thrombolytic therapy. Thrombolysis in myocardial infarction (TIMI) 14 investigators. Am J Cardiol. 2000;85(3):299-304.
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-64.
Schröder R. Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction. Circulation. 2004;110(21):e506-e10.
Farkouh ME, Reiffel J, Dressler O, Nikolsky E, Parise H, Cristea E, et al. Relationship between ST-Segment recovery and clinical outcomes after primary percutaneous coronary intervention. Circ Cardiovasc Interv. 2013;6(3):216–23.
Fabris E, van 't Hof A, Hamm CW, et al. Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: a subanalysis of the ATLANTIC trial. Eur Heart J Acute Cardiovasc Care. 2019;8(3):208-17.
Messas N, Hess S, El Adraa A, et al. Impact of manual thrombectomy on myocardial reperfusion as assessed by ST-segment resolution in STEMI patients treated by primary PCI. Arch Cardiovasc Dis. 2014;107(12):672-80.
Ndrepepa G, Alger P, Kufner S, Mehilli J, Schömig A, Kastrati A. ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Cardiol J. 2012;19(1):61-9.
Farkouh ME, Reiffel J, Dressler O, et al. Relationship between ST-segment recovery and clinical outcomes after primary percutaneous coronary intervention: the HORIZONS-AMI ECG substudy report. Circ Cardiovasc Interv. 2013;6(3):216-23.
Buller CE, Fu Y, Mahaffey KW, et al. ST-segment recovery and outcome after primary percutaneous coronary intervention for ST-elevation myocardial infarction: insights from the assessment of Pexelizumab in acute myocardial infarction (APEX-AMI) trial. Circulation. 2008;118(13):1335-46.
Brodie BR, Stuckey TD, Hansen C, et al. Relation between electrocardiographic ST-segment resolution and early and late outcomes after primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2005;95(3):343-8.
Spitaleri G, Brugaletta S, Scalone G, et al. Role of ST-segment resolution in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (from the 5-year outcomes of the EXAMINATION [evaluation of the Xience-V stent in acute myocardial infarction] trial). Am J Cardiol. 2018;121(9):1039-45.
Masoumkhani F, Gohari S, Reshadmanesh T, Ahangar H, Faghihzadeh S. Association between ST-segment resolution after primary angioplasty and short-term outcomes in patients with acute myocardial infarction. Minerva Cardiol Angiol. 2021;69(2):133-40.
Files | ||
Issue | Vol 7 No 3 (2023): Summer (July) | |
Section | Original article | |
DOI | 10.18502/fem.v7i3.13821 | |
Keywords | ||
Complete ST-segment Resolution ECG Primary PCI Prognosis ST-segment Elevation Myocardial Infarction |
Rights and permissions | |
![]() |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |