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Maletin S, Petrović M, Stojšić-Milosavljević A, Miljković T, Milovančev A, Petrović I, Milosavljević I, Balenović A, Čanković M. The Role of QRS Complex and ST-Segment in Major Adverse Cardiovascular Events Prediction in Patients with ST Elevated Myocardial Infarction: A 6-Year Follow-Up Study. Diagnostics (Basel) 2024; 14:1042. [PMID: 38786340 PMCID: PMC11120035 DOI: 10.3390/diagnostics14101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND as a relatively high number of ST-segment elevation myocardial infarction (STEMI) patients develop major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI), our aim was to determine the significance, and possible predictive value of QRS complex width and ST-segment elevation. METHODS our patient sample included 200 PCI-treated STEMI patients, which were divided into two groups based on the following duration of symptoms: (I) less than 6 h, and (II) 6 to 12 h. For every patient, an ECG was performed at six different time points, patients were followed for up to six years for the occurrence of MACE. RESULTS the mean age was 60.6 ± 11.39 years, and 142 (71%) were male. The 6-12 h group had significantly wider QRS complex, higher ST-segment elevation, lower prevalence of ST-segment resolution as well as MACE prevalence (p < 0.05). ECG parameters, QRS width, and magnitude of ST-segment elevation were proved to be independent significant predictors of MACE in all measured time points (p < 0.05). Even after controlling for biomarkers of myocardial injury, these ECG parameters remained statistically significant predictors of MACE (p < 0.05). CONCLUSION our study highlights that wider QRS complex and a more pronounced ST-segment elevation are associated with longer total ischemic time and higher risk of long-term MACE.
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Affiliation(s)
- Srđan Maletin
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Milovan Petrović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Anastazija Stojšić-Milosavljević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Ivan Petrović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
| | - Isidora Milosavljević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
| | - Ana Balenović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
| | - Milenko Čanković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
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Fabiszak T, Kasprzak M, Koziński M, Kubica J. Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction. J Clin Med 2021; 10:5445. [PMID: 34830726 PMCID: PMC8619668 DOI: 10.3390/jcm10225445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). METHODS We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. RESULTS Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45-48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22-2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04-0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke's pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). CONCLUSIONS According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.
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Affiliation(s)
- Tomasz Fabiszak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81-519 Gdynia, Poland;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
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Muraca I, Pennesi M, Mattesini A, Migliorini A, Carrabba N, Virgili G, Bruscoli F, Demola P, Colombi R, Pontecorboli G, Marchionni N, Di Mario C, Valenti R. Comparison of myocardial reperfusion between intracoronary versus intravenous cangrelor administration in patients undergoing primary percutaneous coronary intervention. Cardiol J 2021; 30:587-594. [PMID: 34581427 PMCID: PMC10508075 DOI: 10.5603/cj.a2021.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Myocardial reperfusion is the main target of treatment in patients with ST-segment elevation myocardial infarction (STEMI). The intracoronary administration of cangrelor bolus could favor a higher local drug concentration, favoring an earlier thrombotic resolution and a reduced distal micro-embolization. METHODS Seventy-one patients undergoing primary percutaneous coronary intervention (PCI) for STEMI: 37 treated with intracoronary and 34 with intravenous bolus administration of cangrelor. The primary endpoint was ST-segment elevation resolution (STR) ≥ 50% after 30 min from the end of the PCI. Other explorative reperfusion indices investigated were: STR ≥ 50% at 24 hours, STR ≥ 70% at 30 min, Thrombolysis In Myocardial Infarction frame count and the QT dispersion. Moreover, acute and subacute stent thrombosis, bleeding events and 30-day mortality have been evaluated. RESULTS More frequent STR ≥ 50% was observed in the intravenous cangrelor bolus group as compared to the intracoronary administration at 30 min (71.9% vs. 45.5%; p = 0.033), the difference was maintained 24 hours after PCI (87.1% vs. 63.6%; p = 0.030). STR ≥ 70% at 30 min was statistically more frequent in the intravenous bolus administration cohort (66.7% vs. 28.6% p = 0.02). At multivariable analysis, intravenous cangrelor administration was significantly related to STR ≥ 50% (odds ratio: 3.586; 95% confidence interval: 1.134-11.335; p = 0.030). The incidence of Bleeding Academic Research Consortium 3-5 bleedings was 15.5% and mortality was 4.2% without any significant difference between the two groups. CONCLUSIONS In conclusion the results of the study do not show any advantages in the administration of intracoronary bolus of cangrelor in patients affected by STEMI and treated with primary PCI.
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Affiliation(s)
- Iacopo Muraca
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Matteo Pennesi
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Intervention Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Angela Migliorini
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Nazario Carrabba
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Giacomo Virgili
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
| | - Filippo Bruscoli
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
| | - Pierluigi Demola
- Structural Intervention Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Riccardo Colombi
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
| | - Giulia Pontecorboli
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Intervention Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Renato Valenti
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy.
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Bianco HT, Povoa R, Izar MC, Luna Filho B, Moreira FT, Stefanini E, Fonseca HA, Barbosa AHP, Alves CMR, Caixeta AM, Gonçalves I, Moraes PIDM, Lopes RD, Paola AAVD, Almeida D, Moises VA, Fonseca FAH. Accuracy of Post-thrombolysis ST-segment Reduction as an Adequate Reperfusion Predictor in the Pharmaco-Invasive Approach. Arq Bras Cardiol 2021; 117:15-25. [PMID: 34320062 PMCID: PMC8294746 DOI: 10.36660/abc.20200241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Fundamento A intervenção coronária percutânea primária é considerada o “padrão-ouro” para reperfusão coronária. Entretanto, quando não disponível, a estratégia fármaco-invasiva é método alternativo, e o eletrocardiograma (ECG) tem sido utilizado para identificar sucesso na reperfusão. Objetivos Nosso estudo teve como objetivo examinar alterações no segmento-ST pós-lise e seu poder de prever a recanalização, usando os escores angiográficos TIMI e blush miocárdio (MBG) como critério de reperfusão ideal. Métodos Foram estudados 2.215 pacientes com infarto agudo do miocárdio com supra-ST submetidos à fibrinólise [(Tenecteplase)-TNK] e encaminhados para angiografia coronária em até 24 h pós-fibrinólise ou imediatamente encaminhados à terapia de resgate. O ECG foi realizado pré-TNK e 60 min-pós. Os pacientes foram categorizados em dois grupos: aqueles com reperfusão ideal (TIMI-3 e MBG-3) e aqueles com reperfusão inadequada (fluxo TIMI <3). Foi definido o critério de reperfusão do ECG pela redução do segmento ST >50%. Consideramos p-valor <0,05 para as análises, com testes bicaudais. Resultados O critério de reperfusão pelo ECG apresentou valor preditivo positivo de 56%; valor preditivo negativo de 66%; sensibilidade de 79%; e especificidade de 40%. Houve fraca correlação positiva entre a redução do segmento-ST e os dados angiográficos de reperfusão ideal (r = 0,21; p <0,001) e baixa precisão diagnóstica, com AUC de 0,60 (IC-95%; 0,57-0,62). Conclusão Em nossos resultados, a redução do segmento-ST não conseguiu identificar com precisão os pacientes com reperfusão angiográfica apropriada. Portanto, mesmo pacientes com reperfusão aparentemente bem-sucedida devem ser encaminhados à angiografia brevemente, a fim de garantir fluxo coronário macro e microvascular adequados.
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Affiliation(s)
- Henrique Tria Bianco
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Rui Povoa
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | | | | | - Flavio Tocci Moreira
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | | | | | | | - Adriano Mendes Caixeta
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Iran Gonçalves
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | | | - Renato Delascio Lopes
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Duke University Hospital, Durham, North Carolina - EUA
| | | | - Dirceu Almeida
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | - Valdir Ambrosio Moises
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
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Cimino S, Pighi M. Prognostic value of ST-segment monitoring after primary percutaneous coronary intervention: still an issue? Minerva Cardiol Angiol 2021; 69:130-132. [PMID: 33929137 DOI: 10.23736/s2724-5683.20.05335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sara Cimino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy -
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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 2020; 69:133-140. [PMID: 32492986 DOI: 10.23736/s2724-5683.20.05109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the relationship between the early/late complete ST-resolution and short-term cardiovascular outcomes in patients undergoing primary angioplasty. METHODS This was a prospective cross-sectional study of patients with acute myocardial infarction who candidate for primary percutaneous coronary intervention (PCI) during 1 year. An ECG obtained at the time of admission, 90 minutes and 24 hour after PCI. Patients were followed up for in hospital and 1-year outcomes and then data assessed according to the ST segment resolution (STR) (complete ≥70% and incomplete <70% STR). RESULTS Overall, 124 patients included in the study. The rates of complete STR were 44.4% after 90 minutes and 82.3% after 24 hours. Patients with early complete STR had significant lower rates of heart failure after 1-year follow-up (32% versus 46%, OR: 1.88, 95% CI: 1.42-2.50, P=0.005) but not like patients with late STR. No significant relationship was observed between early/late complete STR and re-infarction, stroke, re-hospitalization and death during 1-year follow-up (P>0.05). Moderate correlations were found between percentage of ST resolution after 90 minutes and EF before discharge and final EF (correlation coefficient: 0.395 and 0.488, respectively, P<0.001). CONCLUSIONS Early complete STR can be an indicator for development of heart failure after 1-year follow-up.
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Affiliation(s)
- Fatemeh Masoumkhani
- Department of Cardiology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Sepehr Gohari
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Tara Reshadmanesh
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hassan Ahangar
- Department of Cardiology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran -
| | - Soghrat Faghihzadeh
- Department of Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Tarantino N, Santoro F, Guastafierro F, Di Martino LFM, Scarcia M, Ieva R, Ruggiero A, Cuculo A, Mariano E, Di Biase M, Brunetti ND. "Lambda-wave" ST-elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy. Ann Noninvasive Electrocardiol 2018; 23:e12581. [PMID: 29984535 DOI: 10.1111/anec.12581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Persistent ST-segment elevation in acute coronary syndrome is associated with both short and long-term complications. By contrast, there is limited information about ST-elevation and its evolution during takotsubo (stress) cardiomyopathy (TTC). AIM To evaluate whether persistent downsloping ST-elevation in the early stages of TTC might correlate with short and long-term clinical events. METHODS One-hundred fifty-eight consecutive subjects with TTC were prospectively enrolled and assessed by electrocardiogram. Patients were classified in two groups according to the presence of downsloping ST-elevation ≥5 mm lasting at least 24 hr ("lambda-wave" ST-elevation group vs. without downsloping ST-elevation) in at least one/two contiguous leads. RESULTS Five (3.2%) patients, all female with a mean left ventricular ejection fraction 32 ± 5%, were included in the lambda-wave ST-elevation group. These patients were characterized by a higher prevalence of physical stressor (100% vs. 49%, p = 0.04) and higher admission and peak levels of troponin-I levels during hospitalization. Peak of ST-elevation in the lambda-wave ST-elevation group was reached 6 hr after admission and gradually decreased after 24 hr. In-hospital complications were observed in all the patients presenting lambda ST-elevation (100% vs. 23%, p = 0.03, OR: 29.1, p = 0.04); one patient presented endoventricular thrombosis and two died of cardiogenic shock. At long-term follow-up (mean 443 days), adverse events were observed in 80% of patients with lambda-wave ST-elevation (RR of adverse events at follow-up 32, p < 0.01). CONCLUSION Persistent downsloping lambda-wave ST-elevation during the acute phase of stress cardiomyopathy may be associated with a higher risk of adverse events at short and long-term follow-up.
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Affiliation(s)
- Nicola Tarantino
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Francesco Santoro
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy.,Asklepios Klinik - St. Georg, Hamburg, Germany
| | | | | | - Maria Scarcia
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Riccardo Ieva
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Antonio Ruggiero
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Andrea Cuculo
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Enrica Mariano
- Department of Cardiology, University "Tor Vergata", Rome, Italy
| | - Matteo Di Biase
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
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Cuenin L, Lamoureux S, Schaaf M, Bochaton T, Monassier JP, Claeys MJ, Rioufol G, Finet G, Garcia-Dorado D, Angoulvant D, Elbaz M, Delarche N, Coste P, Metge M, Perret T, Motreff P, Bonnefoy-Cudraz E, Vanzetto G, Morel O, Boussaha I, Ovize M, Mewton N. Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction - Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year. Circ J 2017; 82:1379-1386. [PMID: 28943533 DOI: 10.1253/circj.cj-17-0671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance.Methods and Results:A standard 12-lead electrocardiogram (ECG) was recorded in 662 patients with anterior STEMI referred for primary percutaneous coronary intervention (PPCI). ECGs were recorded 60-90 min after PPCI and at discharge. ST segment re-elevation was defined as a ≥0.1-mV increase in STMax between the post-PPCI and discharge ECGs. Infarct size (assessed as creatine kinase [CK] peak), echocardiography at baseline and follow-up, and all-cause death and heart failure events at 1 year were assessed. In all, 128 patients (19%) had ST segment re-elevation. There was no difference between patients with and without re-elevation in infarct size (CK peak [mean±SD] 4,231±2,656 vs. 3,993±2,819 IU/L; P=0.402), left ventricular (LV) ejection fraction (50.7±11.6% vs. 52.2±10.8%; P=0.186), LV adverse remodeling (20.1±38.9% vs. 18.3±30.9%; P=0.631), or all-cause mortality and heart failure events (22 [19.8%] vs. 106 [19.2%]; P=0.887) at 1 year. CONCLUSIONS Among anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size or major adverse events at 1 year.
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Affiliation(s)
- Léo Cuenin
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | - Mathieu Schaaf
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Thomas Bochaton
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | | | - Gilles Rioufol
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Gérard Finet
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | | | - Meyer Elbaz
- Centre Hospitalier Universitaire de Rangueil
| | | | | | | | | | | | | | | | | | - Inesse Boussaha
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Michel Ovize
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
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9
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van der Zwaan H, Stoel M, Roos-Hesselink J, Veen G, Boersma E, von Birgelen C. Early versus late ST-segment resolution and clinical outcomes after percutaneous coronary intervention for acute myocardial infarction. Neth Heart J 2010; 18:416-22. [PMID: 20862236 PMCID: PMC2941127 DOI: 10.1007/bf03091808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background. Absence of complete ST-segment resolution (STR) after percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI) is a determinant of mortality. Traditionally, STR is determined on the coronary care unit (CCU) 60 to 90 minutes after the initiation of reperfusion therapy. We studied the prognostic value of STR immediately after PCI. Methods. We analysed 223 consecutive patients with STEMI and successful PCI. Continuous ECG data were collected during PCI and at 30 minutes after arrival on the CCU (mean time 81±17 minutes after reflow of the culprit artery). Patients were divided into three groups: patients with complete STR immediately after PCI ('early'), patients with complete and persistent STR at 30 minutes on the CCU, but not immediately after PCI ('late') and patients without STR. One-year follow-up was obtained for death and rehospitalisation for major adverse cardiac events. Cox proportional hazards regression was used to evaluate the association between STR and outcome. Results. Early STR occurred in 115 (52%) and late STR in 43 (19%) patients. Patients with early or late STR had a lower incidence of one-year cardiac death than those without STR (1.9 vs. 9.2%; p=0.02). In contrast, rehospitalisation occurred more frequently in patients with early or late STR (20.3 vs. 6.2%; p=0.009). As compared with patients without STR, early and late STR had a similar prognostic value (hazard ratios [95% confidence interval] for cardiac death 0.40 [0.08-2.03] and 0.25 [0.03-2.08]).Conclusions. We found no (major) change in prognostic value of STR during the 0 to 90 minutes time window after PCI. (Neth Heart J 2010;18:416-22.).
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Affiliation(s)
- H.B. van der Zwaan
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M.G. Stoel
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J.W. Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - G. Veen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - E. Boersma
- Department of Epidemiology and Statistics, Erasmus University, Rotterdam, the Netherlands
| | - C. von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, and Institute of Biomedical Technology, University of Twente, Enschede, the Netherlands
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