Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention

Jacob Lønborg; Henning Kelbæk; Lene Holmvang; Steffen Helqvist; Niels Vejlstrup; Erik Jørgensen; Kari Saunamäki; Nadia P Dridi; Lene Kløvgaard; Anne Kaltoft; Hans Erik Bøtker; Jens F Lassen; Peter Clemmensen; Christian Juhl Terkelsen; Thomas Engstrøm

doi:10.1016/j.amjcard.2016.03.009

Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention

Jacob Lønborg, Henning Kelbæk, Lene Holmvang, Steffen Helqvist, Niels Vejlstrup, Erik Jørgensen, Kari Saunamäki, Nadia P Dridi, Lene Kløvgaard, Anne Kaltoft, Hans Erik Bøtker, Jens F Lassen, Peter Clemmensen, Christian Juhl Terkelsen, Thomas Engstrøm

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution.

Original language	English
Journal	The American Journal of Cardiology
Volume	117
Issue number	11
Pages (from-to)	1735-40
Number of pages	6
ISSN	0002-9149
DOIs	https://doi.org/10.1016/j.amjcard.2016.03.009
Publication status	Published - 1 Jun 2016

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Journal Article

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10.1016/j.amjcard.2016.03.009

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Lønborg, J., Kelbæk, H., Holmvang, L., Helqvist, S., Vejlstrup, N., Jørgensen, E., Saunamäki, K., Dridi, N. P., Kløvgaard, L., Kaltoft, A., Bøtker, H. E., Lassen, J. F., Clemmensen, P., Terkelsen, C. J., & Engstrøm, T. (2016). Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention. The American Journal of Cardiology, 117(11), 1735-40. https://doi.org/10.1016/j.amjcard.2016.03.009

Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention. / Lønborg, Jacob; Kelbæk, Henning; Holmvang, Lene et al.
In: The American Journal of Cardiology, Vol. 117, No. 11, 01.06.2016, p. 1735-40.

Research output: Contribution to journal › Journal article › Research › peer-review

Lønborg, J, Kelbæk, H, Holmvang, L, Helqvist, S, Vejlstrup, N, Jørgensen, E, Saunamäki, K, Dridi, NP, Kløvgaard, L, Kaltoft, A, Bøtker, HE, Lassen, JF, Clemmensen, P, Terkelsen, CJ & Engstrøm, T 2016, 'Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention', The American Journal of Cardiology, vol. 117, no. 11, pp. 1735-40. https://doi.org/10.1016/j.amjcard.2016.03.009

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abstract = "Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution.",

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T1 - Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention

AU - Lønborg, Jacob

AU - Kelbæk, Henning

AU - Holmvang, Lene

AU - Helqvist, Steffen

AU - Vejlstrup, Niels

AU - Jørgensen, Erik

AU - Saunamäki, Kari

AU - Dridi, Nadia P

AU - Kløvgaard, Lene

AU - Kaltoft, Anne

AU - Bøtker, Hans Erik

AU - Lassen, Jens F

AU - Clemmensen, Peter

AU - Terkelsen, Christian Juhl

AU - Engstrøm, Thomas

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution.

AB - Some patients presenting with ST-segment elevation myocardial infarction (STEMI) have complete ST resolution in the electrocardiogram, which may be clinical useful in the triage of patients with STEMI. However, the importance of complete ST resolution in these patients remains uncertain. Thus, the purpose was to describe the prognosis of patients with complete ST resolution before primary percutaneous coronary intervention (PCI). Continuous ST monitoring from arrival until 90 minutes after PCI was performed in 933 patients with STEMI. Complete ST resolution was defined as no residual significant ST elevations before intervention. The patients were followed clinically for 5.5 years (range 0 to 6.8 years). Infarct size and myocardial salvage were assessed in a subgroup of patients (n = 221) by cardiovascular magnetic resonance. Complete ST resolution was observed in 24% of the patients, who had a higher incidence of Thrombolysis In Myocardial Infarction grade 2/3 flow before intervention (64% vs 24%), smaller infarct size (6% vs 11%), and higher myocardial salvage index (0.82 vs 0.69; all p <0.001) compared with patients with continuous ST elevations. Complete ST resolution was associated with a significantly lower rate of the composite end point of all-cause death and admission for heart failure (14% vs 22%; p = 0.006) although it only tended to be an independent predictor in a multivariate analysis (hazard ratio 0.69, 95% CI 0.49 to 1.06; p = 0.09). In conclusion, compared to patients without incomplete ST resolution, patients with STEMI and complete ST resolution before primary PCI have a higher incidence of normalized epicardial flow before PCI, a larger myocardial salvage and smaller infarct size after the procedure and presumably improved long-term outcome compared with incomplete ST resolution.

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DO - 10.1016/j.amjcard.2016.03.009

M3 - Journal article

C2 - 27062938

SN - 0002-9149

VL - 117

SP - 1735

EP - 1740

JO - The American Journal of Cardiology

JF - The American Journal of Cardiology

IS - 11

ER -

Comparison of Outcome of Patients With ST-Segment Elevation Myocardial Infarction and Complete Versus Incomplete ST-Resolution Before Primary Percutaneous Coronary Intervention

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