Reperfused ST-elevation Myocardial Infarction Research Articles

Cardio-pulmonary transit-time by cardiac magnetic resonance imaging: associates to infarct severity and adverse events after reperfused STEMI

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac magnetic resonance (CMR) data on cpTT and its associates with infarct characteristics and clinical outcome after reperfused ST-elevation myocardial infarction (STEMI) are lacking so far. Purpose To investigate cardiopulmonary-transit-time (cpTT) and its value as surrogate parameter for integrative cardiac performance and its link to heart failure. Methods A total of 207 patients (179 men [87%], median age 55 [interquartile range (IQR) 49-64] with acute STEMI underwent CMR on day 3 [IQR 2-4] and 4 months (m) [IQR 4-5] after primary percutaneous coronary intervention. cpTT was taken as the time between the peaks of time-intensity curves of gadolinium contrast to pass from the right ventricle (RV) to the left ventricle (LV). Infarct size, extent of microvascular obstruction (MVO), RV and LV dimensions and function were assessed at both occasions. Results cpTT decreased significantly between baseline and 4m CMR scan (8.6 seconds [IQR 7.5-9.6] to 7.8 sec [IQR 7-8.7], respectively, p < 0.0001). Patients with presence of MVO had significantly prolonged cpTT at baseline and 4m follow-up (all p < 0.022). According to Cox regression analysis ("functional model") baseline cpTT (hazard ratio (HR) 1.5, 95% confidence interval (CI) 1.1–2.2; p= 0.008) remained significantly associated to the occurrence of major adverse cardiac events (MACE) after adjustment for LV ejection fraction (EF) and cardiac index. According to Cox regression analysis ("tissue model") baseline cpTT (HR 1.462, 95% CI 1.02–2.09, p= 0.039) as well as extent of MVO (HR 1.196, 95% CI 1.081–1.324, p= 0.001) remained significantly associated to MACE after adjustment for infarct size. Baseline cpTT (area under the curve [AUC]: 0.725, 95% confidence interval [CI] 0.57-0.88; p < 0.009) was significantly higher for the prediction of MACE compared to LV ejection fraction (AUC: 0.686, 95% CI 0.51-0.87; p = 0.031. AUC difference: 0.039, p < 0.03). In Kaplan-Meier analysis, cpTT ≥9 sec was associated with clinical adverse cardiovascular events (p = 0.008). Conclusion Following reperfused STEMI, cpTT predicts prognosis independently of infarct size and systolic function. Moreover, cpTT provides significantly higher prognostic implication in comparison with LV ejection fraction.

The Fractalkine Receptor CX3CR1 Links Lymphocyte Kinetics in CMV-Seropositive Patients and Acute Myocardial Infarction With Adverse Left Ventricular Remodeling.

AimsLatent cytomegalovirus (CMV) infection is associated with adverse cardiovascular outcomes. Virus-specific CX3CR1+ effector memory T-cells may be instrumental in this process due to their pro-inflammatory properties. We investigated the role of CX3CR1 (fractalkine receptor) in CMV-related lymphocyte kinetics and cardiac remodeling in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).Methods and ResultsWe retrospectively analysed lymphocyte count, troponin, and survival in 4874 STEMI/pPCI patients, evaluated lymphocyte kinetics during reperfusion in a prospective cohort, and obtained sequential cardiac MRI (cMRI) to assess remodeling. Pre-reperfusion lymphopenia independently predicted mortality at 7.5 years. Prior to reperfusion, CCR7+ T-lymphocytes appeared to be depleted. After reperfusion, T-lymphocytes expressing CX3CR1 were depleted predominantly in CMV-seropositive patients. During ischaemia/reperfusion, a drop in CX3CR1+ T-lymphocytes was significantly linked with microvascular obstruction in CMV+ patients, suggesting increased fractalkine-receptor interaction. At 12 weeks, CMV+ patients displayed adverse LV remodeling.ConclusionWe show that lymphopenia occurs before and after reperfusion in STEMI by different mechanisms and predicts long-term outcome. In CMV+ patients, increased fractalkine induction and sequestration of CX3CR1+ T-cells may contribute to adverse remodeling, suggesting a pro-inflammatory pathomechanism which presents a novel therapeutic target.

Impact of emergency medical service delays on time to reperfusion and mortality in STEMI

ObjectivesTo explore the relationship between emergency medical service (EMS) delay time, overall time to reperfusion and clinical outcome in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention...

Percutaneous Coronary Intervention (PCI) Accounts for Fall in Long-Term Mortality in ST-Elevation Myocardial Infarction (STEMI) from 2003-2016 in New South Wales, Australia: A Population-Linkage Data Analysis

Reperfusion for STEMI is optimally achieved by timely performance of PCI which has become more widely available in Australia in recent years. We evaluated the association between frequency of PCI for STEMI and mortality over a 13-year period in a state-wide cohort.

Disparity in Management of STEMI—Factors Leading to Missed Acute Myocardial Infarction (MAMI) in Rural Areas

Early reperfusion for ST-Elevation Myocardial Infarction (STEMI) is well-known to improved patient outcomes. Recent auditing had indicated that not all STEMI patients were receiving timely reperfusion. Consequently, investigation into the factors influencing clinical decision making by primary care providers in rural STEMI patients was undertaken.

Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI.

The current ST-elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI) paradigm prevents some NSTEMI patients with acute coronary occlusion from receiving emergent reperfusion, in spite of their known increased mortality compared with NSTEMI without occlusion. We have proposed a new paradigm known as occlusion MI vs. nonocclusion MI (OMI vs. NOMI). We aimed to compare the two paradigms within a single population. We hypothesized that STEMI(-) OMI would have characteristics similar to STEMI(+) OMI but longer time to catheterization. We performed a retrospective review of a prospectively collected acute coronary syndrome population. OMI was defined as an acute culprit and either TIMI 0-2 flow or TIMI 3 flow plus peak troponin T>1.0ng/mL. We collected electrocardiograms, demographic characteristics, laboratory results, angiographic data, and outcomes. Among 467 patients, there were 108 OMIs, with only 60% (67 of 108) meeting STEMI criteria. Median peak troponin T for the STEMI(+) OMI, STEMI(-) OMI, and no occlusion groups were 3.78 (interquartile range [IQR] 2.18-7.63), 1.87 (IQR 1.12-5.48), and 0.00 (IQR 0.00-0.08). Median time from arrival to catheterization was 41min (IQR 23-86min) for STEMI(+) OMI compared with 437min (IQR 85-1590min) for STEMI(-) OMI (p<0.001). STEMI(+) OMI was more likely than STEMI(-) OMI to undergo catheterization within 90min (76% vs. 28%; p<0.001). STEMI(-) OMI patients had significant delays to catheterization but adverse outcomes more similar to STEMI(+) OMI than those with no occlusion. These data support the OMI/NOMI paradigm and the importance of further research into emergent reperfusion for STEMI(-) OMI.

Role of CMV-serostatus and CX3CR1 on lymphocyte kinetics and left ventricular remodelling in patients with acute myocardial infarction

Abstract Background Patients with latent cytomegalovirus (CMV) infection have higher rates of adverse cardiovascular outcomes, but the reasons for this remain elusive. CMV-induced changes to T-lymphocyte populations, with a proliferation of CMV-specific, CX3CR1+ effector memory cells, may contribute. Effector T-cells are associated with cardiovascular mortality in CMV positive patients, and ischaemia-reperfusion injury after ST-elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention (pPCI). Purpose To investigate the effect of CMV status on lymphocyte kinetics and cardiac MRI (cMRI) parameters in 52 STEMI patients receiving pPCI, and examine the prognostic relevance of pre-reperfusion lymphocyte count in a large cohort. Methods We retrospectively analysed the association between pre-reperfusion lymphocyte count, troponin, and long-term survival in 4874 consecutive STEMI patients. Using flow cytometry, we analysed lymphocyte kinetics in 52 STEMI patients, of known CMV status, during and after pPCI. We assessed the impact of CMV status on infarct size, left-ventricular (LV) function and microvascular obstruction with cMRI in the first week after reperfusion in 101 patients. Repeat cMRI at 12 weeks, to assess LV remodelling, was obtained in 48 patients. Results Pre-reperfusion lymphopenia is an independent predictor of mortality over 7.5 years (hazard ratio for lowest vs highest quartile: 2.0; 95% CI 1.7–2.4; p&amp;lt;0.001), and is associated with higher admission troponins (p&amp;lt;0.001 for lowest vs second-lowest quartile), suggesting lymphocyte count falls prior to reperfusion in response to myocardial injury. CMV positive patients had more cytotoxic T-cells, strongly expressing the fractalkine receptor, CX3CR1. In CMV positive patients these cells fell dramatically by 90 minutes post-reperfusion, and dropped more sharply in patients with extensive microvascular obstruction on cMRI (p≤0.05 in all effector subsets). CX3CR1 expression was lower at 90 minutes post-reperfusion than at 24 hours (return to physiological expression) in all effector T-cell subsets. All subsets lost a similar proportion of their 24-hour value, but consistently lost a larger proportion in CMV positive patients (−27% in CMV+, −18% in CMV−; p=0.007). CX3CR1 expression falls in the presence of fractalkine, and we hypothesise that membrane-bound fractalkine is induced more strongly in CMV positive patients, as soluble fractalkine levels were similar. At 12 weeks, LV remodeling was worse in CMV positive patients (change in end-diastolic volume: +10.7ml vs −6.1ml; p=0.02). Conclusions Lymphopenia occurs prior to reperfusion in STEMI, and predicts long-term mortality. Effector T-cells drop substantially after reperfusion only in CMV positive patients, likely mediated by CX3CR1-fractalkine interaction, and this is associated with adverse cMRI findings. Remodeling is worse in CMV positive patients at 12 weeks post-STEMI. Lymphocytes, troponin and survival Funding Acknowledgement Type of funding source: Public Institution(s)

Peak white blood cell count, infarct size and myocardial salvage in patients with reperfused ST-elevation myocardial infarction: a cardiac magnetic resonance study

Peak white blood cell count, infarct size and myocardial salvage in patients with reperfused ST-elevation myocardial infarction: a cardiac magnetic resonance study

Reperfusion of ST-Segment-Elevation Myocardial Infarction in the COVID-19 Era: Business as Usual?

Reperfusion of ST-Segment-Elevation Myocardial Infarction in the COVID-19 Era: Business as Usual?

Impact of Morphine Treatment on Infarct Size and Reperfusion Injury in Acute Reperfused ST-Elevation Myocardial Infarction

Current evidence regarding the effect of intravenous morphine administration on reperfusion injury and/or cardioprotection in patients with myocardial infarction is conflicting. The aim of this study was to evaluate the impact of morphine administration, on infarct size and reperfusion injury assessed by cardiac magnetic resonance imaging (CMR) in a large multicenter ST-elevation myocardial infarction (STEMI) population. In total, 734 STEMI patients reperfused by primary percutaneous coronary intervention <12 h after symptom onset underwent CMR imaging at eight centers for assessment of myocardial damage. Intravenous morphine administration was recorded in all patients. CMR was completed within one week after infarction using a standardized protocol. The clinical endpoint of the study was the occurrence of major adverse cardiac events (MACE) within 12 months after infarction. Intravenous morphine was administered in 61.8% (n = 454) of all patients. There were no differences in infarct size (17%LV, interquartile range [IQR] 8–25%LV versus 16%LV, IQR 8–26%LV, p = 0.67) and microvascular obstruction (p = 0.92) in patients with versus without morphine administration. In the subgroup of patients with early reperfusion within 120 min and reduced flow of the infarcted vessel (TIMI-flow ≤2 before PCI) morphine administration resulted in significantly smaller infarcts (12%LV, IQR 12–19 versus 19%LV, IQR 10–29, p = 0.035) and reduced microvascular obstruction (p = 0.003). Morphine administration had no effect on hard clinical endpoints (log-rank test p = 0.74) and was not an independent predictor of clinical outcome in Cox regression analysis. In our large multicenter CMR study, morphine administration did not have a negative effect on myocardial damage or clinical prognosis in acute reperfused STEMI. In patients, presenting early ( ≤120 min) morphine may have a cardioprotective effect as reflected by smaller infarcts; but this finding has to be assessed in further well-designed clinical studies

Impact of Patient- and System-Level Delays on Reperfusion Among Patients With ST-Elevation Myocardial Infarction

BackgroundPatients with ST-elevation myocardial infarction (STEMI) presenting to percutaneous coronary intervention (PCI)-capable hospitals often experience delays for primary PCI (pPCI). We sought to describe the effect of specific delay intervals and patient/system-level factors on STEMI reperfusion times. MethodsWe analyzed all consecutive patients with STEMI who presented to 2 PCI-capable hospital emergency departments (EDs) between June 2007 and March 2016 who received successful pPCI. We excluded patients with prehospital cardiac arrest. We compared specific system delay intervals, patient characteristics, and in-hospital outcomes among patients who received timely (first medical contact-device ≤90/≤120 minutes) vs delayed >90/>120 minutes) pPCI. ResultsOf 1936 patients with STEMI, 1127 (58%) presented directly to a PCI-capable hospital via emergency health services (EHS), 499 (26%) were transferred from the ED of a non-PCI hospital, and 310 (16%) self-presented to the ED of a pPCI-capable hospital. Guideline-recommended reperfusion times were met in 47% of direct-EHS, 42% of transfers, and 33% of self-presenters. Each time interval from first medical contact to device deployment was significantly prolonged in the delayed vs timely reperfusion cohorts across all 3 groups, excepting vascular access time. ED dwell time contributed the most to the difference in median reperfusion time within each group. Time of presentation, comorbidities, and sex were each significantly associated with delayed reperfusion. Within the EHS-direct group, prolonged reperfusion and ED dwell times were significantly associated with increased mortality, major bleeding, and cardiogenic shock. ConclusionOngoing efforts to identify and reduce ED dwell time and other systemic pPCI delays may improve STEMI outcomes, including mortality.

P4383Machine learning approach for prdiction of postinfarction myocardial recovery using echocardiographic myocardial texture

Abstract Background Recovery of left ventricular (LV) function has significant prognostic significance after myocardial infarction (MI) but is challenging to predict. We applied machine learning algorithms (ML) to analyze echocardiographic myocardial texture for predicting long-term recovery of left ventricular myocardium Methods We used native and contrast-enhanced (Sonovue imaged with Contrast Perfusion Sequence, CPS) myocardial images acquired 7 days after reperfused ST-elevation MI from apical window recorded in 61 pts (19 females, age 59.7±11.9) with first ST-elevation MI treated with successful PCI. A custom software (MaZDa 4.6) was used for texture analysis. 299 image features were calculated for defined regions of interest in each image (9 features from histogram, 6 from gradient matrix, 20 from run length matrix, 220 from co-occurrence matrix, and 44 from wavelet transform). Up to 10 most reproducible parameters were selected based on low variation and, later, Fisher criterion with minimization of classification error along with average correlation coefficient. ML methods used to analyze textures included Multilayer perceptron neural network -MLP, support vector machines -SVM, Adaptive Boosting algorithm AdaBoost and library support vector machine. We defined recovery as: improvement of LV wall motion score index (WMSI), absence of remodeling defined as &gt;8% increase in LV end-diastolic volume (LVEDV) and improvement &gt;5% of LV ejection fraction % after 1 year. Results Effectiveness of tested methods was similar for predicting regional and local LV function evolution after one year. Results for native grayscale and red component of CPS myocardial perfusion images were comparable. Percent accuracy of prediction is shown in the table, with best result for WMSI. Accuracy of 1-yr predictions of LV function change ΔWMSI ΔEF ΔLVEDV native grey contrast red contrast grey native grey contrast red contrast grey native grey contrast red contrast grey Adaptive Boosting 78% 79% 78% 64% 64% 59% 61% 60% 60% Neural network 77% 79% 78% 63% 63% 58% 62% 59% 60% Library support vector machine 77% 79% 78% 63% 65% 64% 61% 60% 58% Support vectro machine 77% 79% 78% 64% 65% 59% 61% 60% 58% Conclusions Echocardiographic myocardial texture can be analyzed using machine learning approaches to predict global or regional recovery of myocardial function. Accuracy for predicting regional WMSI improvement was superior to prognosing LVEDV or EF change. Performance of different tools did not differ between native and contrast enhanced images.

Glutathione infusion before primary percutaneous coronary intervention: a randomised controlled pilot study

ObjectiveIn the setting of reperfused ST-elevation myocardial infarction (STEMI), increased production of reactive oxygen species (ROS) contributes to reperfusion injury. Among ROS, hydrogen peroxide (H2O2) showed toxic effects on human...

Primary Unloading and Delayed Reperfusion in ST-Elevation Myocardial Infarction: The STEMI-DTU Trial

Primary Unloading and Delayed Reperfusion in ST-Elevation Myocardial Infarction: The STEMI-DTU Trial

Left Ventricular Thrombus After Primary PCI for ST-Elevation Myocardial Infarction: 1-Year Clinical Outcomes

BackgroundLeft ventricular thrombus formation is a complication of acute myocardial infarction. However, the incidence and risk of systemic thromboembolism in the era of primary angioplasty for ST elevation myocardial infarction (STEMI) is unclear. This study aims to determine clinical outcomes in patients with STEMI treated with primary angioplasty and left ventricular thrombus at 1 year. MethodsPatients who underwent primary angioplasty for STEMI and had a transthoracic echocardiogram were recruited. The primary endpoint was a composite of all-cause mortality, stroke, and systemic thromboembolism at 1 year. For the primary endpoint, the difference between the presence and absence of left ventricular thrombus was compared using a logistic regression, adjusting for minimization variables including age, diabetes mellitus, hypertension, and previous stroke. ResultsOf 2608 patients who underwent primary angioplasty for STEMI, 1645 (63%) patients had a transthoracic echocardiogram performed during the index hospital admission. Forty patients (2.4%) had evidence of left ventricular thrombus on transthoracic echocardiography. Patients with left ventricular thrombus were more likely to develop atrial fibrillation in the immediate postinfarction period (6 [15%] vs 87 [5.4%], P = 0.025). At 1 year, the primary endpoint occurred in 4 (10%) patients with left ventricular thrombus and 146 (9.1%) who did not (logistic regression hazard ratio 0.79, 95% confidence interval 0.23-2.70). ConclusionsIn the contemporary era of mechanical reperfusion for STEMI, echocardiographic detection of left ventricular thrombus was observed in <3% patients. The presence of left ventricular thrombus was not associated with an increased risk of systemic thromboembolism.

Prolonged Tpeak-Tend interval is associated with ventricular fibrillation during reperfusion in ST-elevation myocardial infarction

AimVentricular fibrillation (VF) during reperfusion in ST-elevation myocardial infarction (STEMI) is associated with increased in-hospital mortality. Dispersion of ventricular repolarization contributes to ventricular vulnerability during ischemia. Tpeak-Tend interval was proposed as a ventricular repolarization dispersion marker, however its value for prediction of reperfusion VF remains uncertain. We aimed to assess whether Tpeak-Tend before PCI in STEMI is associated with reperfusion VF. MethodsSTEMI patients admitted for primary PCI were retrospectively assessed for VF during reperfusion. Pre-PCI ECGs recorded in 40 patients with reperfusion VF (rVF group; age 65 ± 13 years, 80% male) were compared with 374 consecutive patients without reperfusion arrhythmias (No-rVF group; age 67 ± 12 years; 68% male). Digital ECGs were automatically processed and Tpeak-Tend interval computed on a per-lead basis. The global Tpeak-Tend was calculated between the earliest Tpeak and the latest Tend in any lead, and tested for association with reperfusion VF using logistic regression analysis. ResultsThe leftward shift of Tpeak toward QRS complex in ischemic leads resulted in Tpeak-Tend prolongation. Global Tpeak-Tend in rVF group was higher than in No-rVF group (142 ± 24 vs 130 ± 27 ms; p = 0.007). Global Tpeak-Tend ≥ 131 ms predicted reperfusion VF (OR = 3.41; 95% CI 1.66–7.04; p = 0.001) and remained a significant predictor of reperfusion VF in multivariable analysis. ConclusionTpeak-Tend interval before PCI in STEMI was an independent predictor of reperfusion VF. Our findings warrants further research aimed at prospective validation of Tpeak-Tend as a marker of periprocedural arrhythmic risk.

Спонтанная реперфузия у пациентов с острым инфарктом миокарда с подъемом сегмента ST

Спонтанная реперфузия у пациентов с острым инфарктом миокарда с подъемом сегмента ST

Impact of direct stenting on myocardial injury assessed by cardiac magnetic resonance imaging and prognosis in ST-elevation myocardial infarction

BackgroundThe results of studies investigating the clinical benefit of a direct stenting (DS) strategy in ST-elevation myocardial infarction (STEMI) are inconsistent and data regarding cardiac magnetic resonance (CMR) parameters of myocardial injury are lacking. The aim of this study was to investigate the effect of DS on myocardial damage in comparison to a conventional stenting technique (CS) with predilation in patients with reperfused STEMI. MethodsIn a subanalysis of the randomized LIPSIA CONDITIONING trial (NCT02158468), STEMI patients were stratified according to the percutaneous coronary intervention technique into the DS (n = 171) or CS (n = 171) group after matching the patients for age (±5 years), gender, and TIMI flow before coronary intervention. Patients underwent CMR imaging within one week after infarction. Clinical outcome (death, reinfarction, hospitalization for heart failure) was assessed within 6 months after the index event. ResultsPatients in the DS group had significantly lower infarct size (16 vs. 19% of left ventricular mass; p = 0.046) and microvascular obstruction with significant improvement of left ventricular parameters, which was associated with favorable clinical outcome with a lower incidence of heart failure hospitalizations (4% vs. 11%, p = 0.011) and mortality (5% vs. 12%, p = 0.034) as compared to patients with CS. In multivariate Cox regression analysis, DS was identified as an independent predictor of reduced mortality (HR 0.30, 95% CI 0.11–0.87, p = 0.026). ConclusionIn patients with acute reperfused STEMI, DS is safe and feasible with a significant reduction of infarct size compared to CS and subsequent lower incidence of heart failure hospitalizations and mortality.

Predictors of myocardial functional recovery following successful reperfusion of acute ST elevation myocardial infarction.

Following acute ST elevation myocardial infarction (STEMI), restoration of large-vessel patency does not mean complete perfusion recovery. Little is known regarding the predictors of successful myocardial reperfusion for the STEMI patients undergoing pharmacologic and mechanical reperfusion strategies. The aim of this clinical study was to find out the predictors of myocardial functional recovery following reperfusion of acute STEMI, represented by 3-month global longitudinal strain (GLS) value assessed by speckle tracking echocardiography. The study population included 400 patients presented with first acute STEMI with successful reperfusion by thrombolysis (group I) or primary percutaneous coronary intervention (PPCI) (group II). Electrocardiography (ECG) at baseline and 90minutes after coronary reperfusion was performed with assessment of ST resolution. Basal and 3-month follow-up echocardiography was performed with assessment of ejection fraction (EF), myocardial performance index (MPI), systolic myocardial excursion (S'), and GLS. There was nonsignificant difference between patients of both groups regarding age (P=0.422) and gender (P=0.272). Also, there was a nonsignificant difference between both groups regarding the risk factors of coronary artery disease like hypertension (P=0.511), diabetes mellitus (P=0.332), and smoking (P=0.381). But there was significant statistical difference between both groups regarding dyslipidemia (P=0.012). Ninety-minute ST resolution was significantly higher in PPCI group (P=0.042). Moreover, PPCI group had significant improvement of EF (P=0.013) during follow-up, and highly significant improvement of MPI, S' and GLS (P˂0.001) compared to the basal echocardiographic study. The percentage of change (∆) of each of the echocardiographic parameter was compared between both groups and revealed statistically significant improvement regarding EF, highly significant improvement of MPI, S' and GLS in favor of PPCI arm (group II). Multivariate regression analysis demonstrated that pain to reperfusion time, MI territory, ST resolution, and basal GLS value are the most important predictors for LV functional recovery. The study found pain to reperfusion time, MI territory, ST resolution, basal GLS value are the most important predictors of myocardial functional recovery. Regular follow-up with echocardiography for STEMI patients with different reperfusion strategies has informative impact on long-term clinical outcome. Also the study confirmed that PPCI is better than thrombolysis not only in restoring epicardial coronary flow but also in restoring microvascular and tissue perfusion assuring better myocardial functional recovery and better long-term clinical outcomes.

P3685Prolonged Tpeak-Tend interval is associated with ventricular fibrillation during reperfusion in ST-elevation myocardial infarction

P3685Prolonged Tpeak-Tend interval is associated with ventricular fibrillation during reperfusion in ST-elevation myocardial infarction