Long-term clinical outcomes and prognoses of ST-segment elevation myocardial infarction patients who present with tombstoning ST-segment elevation.

Abstract

IntroductionAlthough patients with tombstoning ST‐segment elevation (Tomb‐ST) usually have poor in‐hospital and short‐term survival rates, no studies have examined the long‐term clinical outcomes and prognosis of ST‐segment elevation myocardial infarction (STEMI) patients who have this electrocardiographic pattern. Therefore, we aimed to evaluate the long‐term clinical events and mortality of such patients in this study.MethodsIn this retrospective analysis, we included 335 consecutive patients who were diagnosed with acute anterior wall‐STEMI from January 2015 to June 2018. The criteria for the definition of Tomb‐ST were accepted as provided in a previous study. Endpoints of the study were the incidence of significant in‐hospital and long‐term major adverse clinical events (MACE) including the composite of total death, myocardial reinfarction, and hospitalizations due to heart failure.ResultsPatients who presented with Tomb‐ST had significantly higher in‐hospital and long‐term mortality (10% [n = 12 patients] vs. 2.3% [n = 5 patients]; p < 0.001and 6.5% [n = 7 patients] vs. 1.9% [n = 4 patients]; p = .04, respectively). In a multivariate traditional and penalized Cox proportional hazard regression analysis, this type of electrocardiographic pattern was found as independent predictor of long‐term MACE (Odds ratio [OR]: 3.82, 95% confidence interval [CI]: 1.91–7.63, p < .001 and OR: 4.36, 95% CI: 1.97–9.66, p < .001, respectively).ConclusionIn the present study, we observed that the presence of Tomb‐ST might be an independent predictor of long‐term MACE in STEMI patients. To the best of our knowledge, this is the first study to evaluate the long‐term MACE of such patients.