Abstract

BackgroundST resolution (STR) after AMI is a non-invasive indicator of IRA reperfusion. We investigated whether pre-angiography STR predicted spontaneous IRA reperfusion in STEMI patients.MethodPatients with STEMI undergoing primary PCI were recruited. Standard 12-lead ECG tracings were recorded at first medical contact, immediately prior to arterial puncture and 60 min after PCI. STR was classified as total (≥70%; group I), partial (≥30 and < 70%; group II) or none (< 30%; group III). Patients were followed up for 1-year.ResultsThe final analysis included 349 patients (n = 77, 160 and 112 for groups I, II and III, respectively). Compared with groups I/II, pre-procedural TIMI flow in group III was less frequently grades 2 or 3 (P < 0.001). Pre-PCI STR ≥70% was an independent predictor of pre-PCI TIMI-3 flow (OR: 2.8; P < 0.001). Pre-PCI STR < 30% was independently associated with pre-PCI TIMI flow 0–2 (OR: 3.1; P < 0.001). STR = 35.55% seems to be an optimal cut off for pre-procedural TIMI-3 flow prediction with sensitivity 0.943, specificity 0.456, Youden index 0.399, P = 0.027. STR prior to PCI was inversely correlated with 1-year combined CV events rate. STR > 70% may predict a better clinical outcome.ConclusionsAssessment of STR could potentially be used to stratify risk in patients with STEMI before PCI.

Highlights

  • ST resolution (STR) after acute myocardial infarction (AMI) is a non-invasive indicator of infarct-related artery (IRA) reperfusion

  • Post-procedural Thrombolysis in myocardial infarction (TIMI) flow of the IRA is used for risk stratification of patients with STEMI, [2, 3] but pre-procedural TIMI flow may be an important predictor of clinical prognosis [4, 5]

  • We evaluated whether pre-angiography STR reliably predicted spontaneous reperfusion of the IRA in patients with AMI undergoing primary PCI

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Summary

Introduction

ST resolution (STR) after AMI is a non-invasive indicator of IRA reperfusion. Reperfusion of the infarct-related artery (IRA) is a critical predictor of prognosis in patients with acute myocardial infarction (AMI) and may be evaluated either angiographically or non-invasively. Post-procedural TIMI flow of the IRA is used for risk stratification of patients with STEMI, [2, 3] but pre-procedural TIMI flow may be an important predictor of clinical prognosis [4, 5]. It was demonstrated that STR after PCI was a strong and independent predictor of cardiac mortality and recurrence of myocardial infarction (MI) across all spectra of clinical risk, [6, 7, 9] and a lack of STR was even of prognostic value 6 years after the occurrence of AMI [10]

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