ST-segment Resolution In Patients Research Articles

Empagliflozin Effects in Patients with ST-Elevation Myocardial Infarction Undergoing Primary PCI: The EMI-STEMI Randomized Clinical Trial.

Empagliflozin, a sodium-glucose cotransporter 2(SGLT2) inhibitor, improves cardiovascular outcomes in heart failure patients, butdata regarding the efficacy of empagliflozin in the setting of acute myocardial infarction (AMI) isstill unclear. The current study aimed to evaluate whether treatment with empagliflozin before primary percutaneous coronary intervention (PCI) improves parameters associated with patients' outcomes. We randomly assigned 101 non-diabetic and non-heart failure patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI to receive either empagliflozin (10 mg before PCI and once daily for 40 days) or placebo, in addition to the standard treatment. The primary outcomes were changes in left ventricular ejection fraction (LVEF) 40 days after PCI, changes in cardiac troponin I(cTnI) and estimates of its area under the curve (AUC) and the peak level, and resolution of ST-segment in > 50% of leads 90 min after PCI. No significant difference was observed in terms of the occurrence of ST-segment resolution > 50% (46.0% versus 45.0%; p = 0.92) and the mean level of cTnI at each time point between the two groups. The estimated mean [standard deviation (SD)] AUC of cTnI was 955.0 (595.7) ng h/ml in the intervention and 999.7 (474.7) ng h/ml in the control groups (p = 0.85) without any significant difference in peak cTnI level. The mean (SD) LVEF 40 days after primary PCI was significantly higher in empagliflozin-treated patients than the placebo group [43.2% (5.8%) versus 39.2% (6.7%); p = 0.002]. In this study, no significant differences wereobserved across the groups in terms of cTnI levels and ST-segment resolution in patients with STEMI undergoing primary PCI. However, it shed light on the potential benefits of empagliflozin in improving LVEF following STEMI. Iranian Registry of Clinical Trials Platform ( https://irct.behdasht.gov.ir/ ) identifier number IRCT20111206008307N42.

FACTORS AFFECTING ADEQUATE MYOCARDIAL PERFUSION IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION WITH SUCCESSFUL EPICARDIAL FLOW

Aim: The aim of this study was to evaluate and compare multifarious parameters between complete and incomplete ST-segment resolution (STR) patients groups and to identify associates of STR in patients with acute ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (pPCI). 
 Material and Methods: 888 consecutive patients were divided into two groups according to the STR

Elevated plasma homocysteine level is associated with poor ST-segment resolution in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention at high altitude

Abstract Background and purpose: Poor ST-segment resolution (STR) is strongly associated with poor prognosis in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). previous studies suggested higher HCY level in the people who live in high altitudes, so a retrospective analysis is conducted to examine the potential relationship between elevated serum HCY and poor STR after PPCI at high altitudes. Methods: This retrospective analysis included 308 high-altitude dwelling patients (1800-2200 meters elevation from the sea level) undergoing PPCI for STEMI during a period from September 2021 to March 2022. Clinical data were collected and statistically analyzed. Results: In comparison to the patients with normal plasma homocysteine (≤15 mmol/L; n = 155), patients with elevated homocysteine (>15 mmol/L) had higher percentage of men (92.81% vs. 80.00%; p = 0.001) and smoker (79.08% vs. 63.87%; p = 0.003), but no difference in other key baseline characteristics. The rate of complete ST-segment resolution after PPCI (≥ 70%) was 83.23% in the control group and 49.67% in the elevated HCY group (p ≤ 0.001). In multivariable regression analysis, poor ST-segment resolution (<70%) was independently associated with longer pain-to-balloon time (OR 0.832; 95%CI: 0.775–0.894), lower uric acid (OR 1.003; 95%CI: 1.000-1.005), and elevated HCY (OR 0.957 vs. normal HCY; 95%CI: 0.937–0.977). Conclusion: Elevated plasma HCY level was associated with poor ST segment resolution in patients undergoing PPCI STEMI at high altitude.

St Segment Resolution in Patients given Streptokinase Injection along with Guideline directed Medical Therapy

Objective: To determine the ST resolution in patients given streptokinase along with guideline medical therapy Methodology: This descriptive cross sectional study was carried out in department of Cardiology DHQTH KDA Kohat on 109 patients after obtaining informed consent from the patients. Patients were given guideline directed medical therapy & streptokinase for ST elevation MI. The ST-segment elevation resolution was calculated after 90 minutes of treatment with streptokinase, and stratified as complete ST segment resolution (> 70% ST-resolution), partial resolution (30-70% ST-resolution), or failed resolution (< 30% ST-resolution). Results: Out of 109 patients, 33 were females & 76 were male patients. Mean age of the population was 57±11.64 (95% CI). Time from onset of chest pain to administration of thrombolytic & guideline directed medical therapy was within 6 hours for 95 patients (87.5%).Out of 109, 9(8%) patients had minor gum bleeding. Conclusion: Administration of streptokinase is cost effective therapy for STEMI patients & give good resolution of ST segment on ECG. Key Words: Myocardial infarction, ST resolution

The relation of endocan and galectin-3 with ST-segment resolution in patients with ST-segment elevation myocardial infarction.

ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality around the world. In patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), electrocardiographic measures of ST-segment resolution (STR) may give information about the myocardial perfusion and poor prognosis. To investigate the relation of endocan and galectin-3 levels with STR in STEMI patients. In this cross-sectional study, 98 consecutive patients undergoing PPCI for STEMI were enrolled. Synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) scores were recorded. Electrocardiograms were assessed at baseline and 60 min after PPCI. According to STR levels, patients undergoing PPCI (n = 98) were divided into complete STR group (≥70%, n = 53) and incomplete STR group (<70%, n = 45). Serum glucose, total cholesterol, low-density lipoprotein cholesterol, SYNTAX score, endocan and galectin-3 levels were significantly higher and ejection fraction was significantly lower in the incomplete STR (<70%) group (p < 0.05 for all). Body mass index (BMI) (p = 0.046) and galectin-3 (p = 0.037) were independently associated with the SYNTAX score. Endocan (p = 0.044) and galectin-3 (p = 0.017) were independent predictors of incomplete STR. In patients with STEMI, the levels of endocan and galectin-3 may be helpful in identifying patients with a higher risk of insufficient myocardial perfusion and worse clinical outcome after PPCI.

The impact of oral nicorandil pre-treatment on ST resolution and clinical outcome of patients with acute ST-segment elevation myocardial infarction undergoing primary coronary angioplasty: A randomized placebo controlled trial.

Introduction: Literature has shown the effects of intravenous/intracoronary nicorandil on increased myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) treated with mechanical reperfusion. However, the possible cardioprotective effect of oral nicorandil on the clinical outcome prior to primary coronary angioplasty is not well documented. Our aim was to assess the effect of oral nicorandil on primary percutaneous coronary intervention (PPCI). Methods: A total of 240 patients with acute STEMI undergoing PPCI were randomly assigned to oral nicorandil (Intervention, n=116) and placebo (Control, n=124) groups. The intervention group received 20 mg oral nicorandil at the emergency department and another 20 mg oral nicorandil in the catheterization laboratory just before the procedure. The control group received matched placebo. Our primary outcome was ST-segment resolution ≥50% one hour after primary angioplasty. Secondary outcome was in-hospital major adverse cardiovascular events (MACE), defined as a composite of death, ventricular arrhythmia, heart failure and stroke. Results: In the patients of intervention and control groups, the occurrence of ST-segment resolution ≥ 50% were 68.1% and 62.9% respectively, (P =0.27). In-hospital MACE occurred less frequently in the intervention group, compared to placebo group (11.2% vs. 22.5%, P =0.012). Conclusion: Although the administration of oral nicorandil before primary coronary angioplasty did not improve ST-segment resolution in patients with acute STEMI, its promoting effects was remarkable on in-hospital clinical outcomes. Clinical Registration: IRCT20140512017666N1

P3586Influence of morphological features of intracoronary thrombi on ST segment resolution in patients with STEMI after primary PCI

Abstract Background Coronary artery thrombosis is a key element in the onset of STEMI and its further course. Coronary clots significantly vary in their morphological features and types. Perhaps, it may be caused by individual differences in thrombus formation that could have a strong influence on STEMI course and prognosis. Purpose To elucidate the influence of morphological features of intracoronary thrombi (IT) on ST-segment resolution (the outcome) after primary PCI in patients with STEMI. Methods The study included 100 patients with STEMI (female 22%, male 78%) aged 57.81±10.26 years, who underwent PCI with manual thromboaspiration within the first 12 hours (mean 7.22±3.74 h) after the onset of symptoms. The obtained ITs were examined morphologically after hematoxylin &amp; eosin staining by the standard method and by the method proposed by prof. Zerbino that allows determining the antiquity of fibrin according to its color. Each IT was classified by five morphological features: 1) “old” or “fresh” (according to Zerbino's staining); 2) with or without layered structure; and presence or absence of 3) microchannels, 4) peripheral infiltration with neutrophil leukocytes, 5) elements of atherosclerotic plaque. Correlations between these features and incidence of ST-segment resolution in 60 minutes after primary PCI for more than 50% from baseline were analyzed. Results Neither IT antiquity nor presence of the atherosclerotic plaque elements had any significant correlations with ST-segment resolution. Significant positive correlation was revealed with peripheral neutrophil infiltration (r=0.42, p&lt;0.05), and negative correlations were found with layered arrangement IT (r=−0.31, p&lt;0.05) and presence of microchannels (r=−0.56, p&lt;0.05). Statistically significant mathematical prognostic model of ST-segment resolution was obtained after analysis of the co-influence of all five morphological features on the outcome using logistic regression method. It included three IT features significantly correlating with ST-segment resolution: Z = 1.13 − 0.51*V1 − 0.57*V2 − 0.94*V3 where V1 – IT with layered arrangement of fibrin, V2 – IT with microchannels' formation, V3 – IT with peripheral areas of infiltration by the neutrophil leukocytes (1 for the presence of the feature, 0 for its absence). “Old” IT with layered structure Conclusions Morphological features of IT in patients with acute STEMI appear to have significant influence on the primary PCI outcomes. They may be important predictors of the disease course and treatments efficacy. Further investigations of the IT peculiarities and their influences on the course of STEMI may help to improve therapy. Acknowledgement/Funding Study financial support was made by authors

P2728Identification of clinical and laboratory predictors of incomplete ST segment resolution in patients undergoing primary percutaneous intervention for ST elevation myocardial infarction

P2728Identification of clinical and laboratory predictors of incomplete ST segment resolution in patients undergoing primary percutaneous intervention for ST elevation myocardial infarction

Role of ST-Segment Resolution in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention (from the 5-Year Outcomes of the EXAMINATION [Evaluation of the Xience-V Stent in Acute Myocardial Infarction] Trial)

In patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), lack of ST-segment resolution (STR) is associated with poor prognosis at short- and long-term follow-up. The aim of this study was to evaluate the role of STR on very long-term outcomes in patients with STEMI treated with pPCI included in the EXAMINATION (Evaluation of the Xience-V Stent in Acute Myocardial Infarction) trial. Patients were stratified according to the presence of STR < 50% and STR < 70% at the 30-minute post-pPCI electrocardiogram. Primary end point was the patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction, or any revascularization at 5-year follow-up. Both baseline and post-PCI 30-minute electrocardiograms were available for STR assessment in 1,351 patients. Of these patients, 228 (16.9%) and 500 (37.0%) exhibited STR < 50% and STR < 70%, respectively. At 5-year follow-up, the POCE was observed more frequently in patients with STR < 50% (hazard ratio [HR] 1.556; 95% confidence interval [CI] 1.194 to 2.027; p <0.001) and in patients with STR < 70% (HR 1.460, 95% CI 1.169 to 1.824, p <0.001) compared with patients with STR > 50% and STR ≥ 70%, respectively. In both cases, this difference was mainly driven by a significant increase in the rate of all-cause death and any revascularization. After multivariable adjustment, STR < 70%, but not STR < 50%, resulted as a 5-year independent predictor of POCE (adjusted HR 1.338, 95% CI 1.008 to 1.778, p = 0.044). In conclusion, in patients with STEMI, the evaluation of 70% STR after pPCI provides independent prognostic information at 5-year follow-up and it can be used to identify patients at high risk of very long-term cardiovascular events.

Assessment of the relationship between reperfusion success and T-peak to T-end interval in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention.

Objective:T-peak–T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI.Methods:In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled; after exclusion, 164 patients were included in the study population.Results:Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%<70) STR. Preprocedural corrected TPE (cTPEPRE;116±21 ms vs. 108±21 ms; p=0.027), postprocedural TPE (TPEPOST; 107±16 ms vs. 92±21 ms; p<0.001), and postprocedural cTPE (cTPEPOST; 119±19 ms vs. 102±17 ms; p<0.001) intervals were significantly longer in patients with incomplete STR than in patients with complete STR, whereas there was no statistically significant difference between the two groups in terms of pre- and postprocedural and corrected QT intervals. cTPEPRE and cTPEPOST were found to be independent predictors for incomplete STR.Conclusion:To our knowledge, this is the first study that evaluated the relationship between TPE interval and no-reflow defined by STR in patients with STEMI who were treated with pPCI.

Remote ischemic conditioning improves myocardial parameters and clinical outcomes during primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials.

We conducted a systematic review and meta-analysis to evaluate the effects of remote ischemic conditioning on myocardial parameters and clinical outcomes in ST segment elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. Ten eligible randomized controlled trials with 1006 STEMI patients were identified. Compared with controls, remote ischemic conditioning reduced the myocardial enzyme levels (standardized mean difference =-0.86; 95% CI: -1.44 to -0.28; P = 0.004; I2 = 94.5%), and increased the incidence of complete ST-segment resolution [odds ratio (OR) = 1.74; 95% CI: 1.09 to 2.77; P = 0.02; I2 = 47.9%]. Remote ischemic conditioning patients had a lower risk of all-cause mortality (OR = 0.27; 95% CI: 0.12 to 0.62; P = 0.002; I2 = 0.0%) and lower major adverse cardiovascular and cerebrovascular events rate (OR=0.45; 95% CI: 0.27 to 0.75; P = 0.002; I2 = 0.0%). Meta-analysis suggested that remote ischemic conditioning conferred cardioprotection by reducing myocardial enzymes and increasing the incidence of complete ST-segment resolution in patients after STEMI. As a result, clinical outcomes were improved in terms of mortality and incidence of major adverse cardiovascular and cerebrovascular events.

SYNTAX score II as a predictor of incomplete ST-segment resolution in patients with acute myocardial infarction treated with primary percutaneous intervention

Background Incomplete ST-segment resolution (STR) is a marker of impaired myocardial perfusion and adverse clinical outcome after primary percutaneous coronary intervention (PPCI). Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery score II (SS-II) has been developed combining anatomical and clinical variables. The aim of the present study was to evaluate the SS-II as a predictor of incomplete STR in patients with ST-segment elevation myocardial infarction (STEMI) treated with PPCI. Patients and methods The present study prospectively included 100 patients with STEMI treated with PPCI. SS-II was determined in all patients. The sum of ST-segment elevation was measured from standard 12-lead ECG obtained on admission and from a second ECG recorded 60 min after PPCI. STR resolution was defined as either complete (≥50%) or incomplete ( Results Patients in the negative STR group were older, had higher prevalence of peripheral vascular disease, lower creatinine clearance (CrCl), higher peak troponin, lower ejection fraction and a higher SS-II (P value = Conclusion SS-II is an independent predictor of incomplete STR in patients with STEMI treated with PPCI.

Association between clinical parameters and ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

Background and objectiveThe aim of this study was to evaluate and compare various parameters between complete and incomplete ST-segment resolution (STR) patients' groups and to identify associates of STR in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) (primary outcome). Materials and methodsA total of 203 consecutive patients were divided into two groups according to the degree of STR: <70% (incomplete) and ≥70% (complete resolution) 5–15min after the PPCI. The cardiovascular risk factors, sex, Killip class, Thrombolysis in Myocardial Infarction (TIMI) flow, symptom-onset-to-balloon time and door-to-balloon time, and adverse cardiovascular events (secondary outcome) were assessed and compared between two groups. ResultsThere were 147 patients with incomplete STR and 56 patients with complete STR. Patients with complete STR were younger, had lower Killip class, shorter duration of the chest pain and were less likely to have anterior myocardial infarction (AMI). Patients in the incomplete STR group had longer symptom-onset-to-balloon and door-to-balloon intervals. TIMI3 flow after PPCI was more common in the complete STR group. TIMI flow ≤2 after PCI, AMI and symptom onset-to-balloon time were inversely associated with STR (beta coefficients −28.635, −28.611, and −0.917, respectively). AMI (OR=29.9), symptom onset-to-balloon time (OR=1.7) and patient's age (OR=1.1) were associated with an increased likelihood of having incomplete STR. ConclusionsPatients with complete STR were younger, had lower Killip class, shorter duration of STEMI, were less likely to have AMI, were more likely to recover TIMI3 flow. Age, TIMI-flow grade 2 or less after PPCI, AMI and symptom-onset-to-balloon time were associated with STR.

Fragmented QRS complexes have predictive value of imperfect ST-segment resolution in patients with STEMI after primary percutaneous coronary intervention

ObjectivesTo investigate the clinical characteristics of patients with the fragmented QRS complexes (fQRS) and the predictive value of fQRS in patients undergoing primary percutaneous coronary intervention (p-PCI). MethodsThe study enrolled 227 consecutive patients with ST-elevation myocardial infarction who underwent p-PCI. Baseline clinical characteristics, the percentage of ST-segment resolution, and parameters of electrocardiography and coronary angiography were investigated. The relationship between fQRS on pre-PCI and post-PCI electrocardiogram and the percentage of ST-segment resolution after PCI were studied. ResultsPatients with fQRS have higher troponin I, creatine kinase-MB levels, prolonged QRS duration, higher Gensini score, lower percentage of total ST-segment resolution, and left ventricular ejection fraction compared with patients without fQRS. Gensini score (odds ratio [OR], 1.013; 95% confidence interval [CI], 1.002-1.024; P < .006) and percentage of total ST-segment resolution (OR, 0.384; 95% CI, 0.186-0.795; P = .01) were independently associated with the presence of fQRS. A multivariate logistic regression analysis selected presence of fQRS pre-PCI (OR, 2.908; 95% CI, 1.095-7.723; P = .032) and the number of leads with fQRS before PCI (OR, 1.582; 95% CI, 1.250-2.002; P < .001) as independent predictors of imperfect ST-segment resolution. ConclusionsThe presence of fQRS is a predictor in ST-elevation myocardial infarction patients undergoing p-PCI. The occurrence of fQRS is beneficial to identify the patients with severe coronary lesion, left ventricular contraction dysfunction, and larger areas of ischemic injury.

Can electrical shock provide ST-segment resolution in patients with ST-segment elevation myocardial ınfarction?

Can electrical shock provide ST-segment resolution in patients with ST-segment elevation myocardial ınfarction?

The relationship between Gensini score and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Clinical outcomes of patients with myocardial infarction are primarily determined by the successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis. To investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimetres was obtained before angioplasty and 60 min after pPCI. ΣSTR < 50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading was calculated according to the results of coronary angiography, and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to STR: those with STR(-), and those with STR(+). Patients were also analysed according to the infarct-related artery. GS-pPCI was significantly higher in patients with STR(-) (10.1 ± 11.8 vs. 22 ± 18.6, p = 0.005). GS-pPCI was inversely correlated with STR (r = -0.287, p = 0.002). In subgroup analysis, patients in the STR(-) group with culprit lesion in left anterior descending artery and left circumflex artery also showed higher GS-pPCI (10.9 ± 13.5 vs. 23.5 ± 21.3, p = 0.03 and 9.6 ± 8.7 vs. 24.1 ± 21, p = 0.04, respectively). High thrombus burden was also observed more frequently in patients with STR(-) (68% vs. 43%, p = 0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR 1.07, 95% CI 1.03-1.12, p = 0.001 and OR 3.28, 95% CI1.11-9.72, p = 0.03, respectively). GS-pPCI and high thrombus burden play an important role in predicting inadequate STR in patients with STEMI treated with pPCI.

Predictive factors predicting inadequate ST-segment resolution in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

Objective To survey ST-segment resolution in STEMI patients undergoing emergency percutaneous coronary intervention (PCI) and to find the specific clinical features of patients with inadequate ST-segment resolution.Methods A total of 198 patients were divided into two groups according to the ratio of ST-segment resolution:relatively adequate ST-segment resolution group (＞ 50％) and inadequate STsegment resolution group (＜ 50％).The clinical features,infarct-related artery and PCI-related evants were evaluated,and major adverse cardiovascular events (MACE including target vessel revascularization,recurrent myocardial infarction,or death) were recorded during hospitalization and follow-up period.Multivariate logistic analysis was used to identify relevant factors influencing ST-segment resolution of STEMI patients after treatment with PCI.The Statistical analyses of data were carried out using SPSS 10.0 software.Results (1) There were 156 patients with relativey adequate ST-segment resolution and 42 patients with inadequate ST-segment resolution.Of them,there were higher percentage of patients aged over 75years in the inadequate ST-segment resolution group than those in the relatively adequate ST-segment resolution group (9 cases,21.4％ vs.14 cases,9.0％ ; P ＜0.05).(2) In inadequate ST-segment resolution group,thetotal ischemic time was significant longer [(5.2 ±2.2) h vs.(3.0 ± 1.6) h,P ＜0.01].The infarctrelated artery (IRA) was more common at left anterior descending coronary artery (LAD) (27 cases,64.3％ vs.69 cases,44.2％; P ＜ 0.05) and there were fewer patients with TIM grade 3 of IRA in inadequate ST-segment resolution group after primary PCI than that in relative adequate ST-segment resolution group (32 cases,76.2％ vs.140 cases,89.7％ ; P ＜ 0.05).There was a lower rate of using GP Ⅱ b/Ⅲ a receptor antagonist and a higher rate of prescribing IABP in inadequate ST-segment resolution group.(3) There is a higher incidence of MACE during hospitalization and follow-up period in patients with inadequate ST-segment resolution.(4) Multivariate logistic analysis indicated that age over 75 years,LAD occlusion,the total ischemic time were related to ST-segment resolution.Conclusions The patients with age over 75 years,LAD occlusion,longer ischemia time,and unemployment GP Ⅱ b/Ⅲ a receptor antagonist before PCI were prone to get inadequate ST-segment resolution and poor prognosis.Age over 75 years,LAD occlusion,and longer ischemic time were independent risk factors of the inadequate ST-segment resolution in STEMI patients after emergency PCI. Key words: ST-segment resolution; Emergency revascularization; ST-segment elevation myocardial infarction ; ECG; ST segment ; Predictive factors ; Emergency interventional therapy ; Clinical characteristics

Value of modified selvester QRS score in prediction of successful reperfusion in patients with acute myocardial infarction

Background Reperfusion therapy basically aims to restore full antegrade flow in the infarct-related epicardial coronary artery. The modified Selvester QRS score, basically developed to estimate infarct size, was used with good predictive value to predict ST-resolution in acute myocardial infarction (AMI) treated with fibrinolysis. However, little data are available about its role in predicting reperfusion in ST-segment myocardial infarction (STEMI) patients undergoing primary percutaneous coronary interventions (PCI). Objectives Was to examine the value of modified Selvester QRS score in predicting ST-segment resolution in patients with first acute STEMI after thrombolytic therapy or primary PCI. Methods Sixty patients with acute STEMI were enrolled in the study, 56 males and 4 females; and their mean age was 56.4 ± 8.4 years. We excluded patients with bundle branch block, paced rhythm, left fascicle block, ECG signs of ventricular hypertrophy, cardiogenic shock and prior STEMI. All patients were submitted to full history taken and clinical examination, admission 12-leads electrocardiography (ECG) with estimation of modified Selvester QRS score and sum of ST-elevation, another ECG after 90 minutes of thrombolysis with estimation of the sum of ST-elevation and ST-resolution, cardiac enzymes, thrombolysis for 45 patients and primary PCI for 15 patients, echocardiographic assessment with measuring of left ventricular ejection fraction (EF) and wall motion score index (WMSI), and coronary angiography. Results Population characteristics and risk factors for coronary artery disease (CAD) were comparable between the two groups. In patients with QRS score > 4, time to admission was significantly higher, EF was significantly lower, WMSI was significantly higher, number of patients with no ST-segment resolution was significantly lower, number of patients with myocardial blush grade (MBG) 1 was significantly higher, number of patients with MBG 3 was significantly lower, and number of patients with three-vessel disease was significantly higher. Sensitivity of QRS score ⩽ 4 in predicting ST-segment resolution ⩾ 50% was 59.3%, specificity was 100%, positive predictive value was 62.1%, negative predictive value was 86%, and overall accuracy was 75.6%. There was a highly significant negative correlation between ST-segment resolution and QRS score (r = −0.483, p = 0.00078). Conclusion Selvester QRS scoring system is regaining its clinical value in patients with first STEMI. It can provide valuable information as regard area of myocardium at risk, prediction of residual left ventricular function, making treatment decisions. Though somewhat difficult, it is worthy to calculate QRS score from admission ECG in every patient presenting with STEMI. In patients who are controversial as regard thrombolytic therapy, QRS score could help in determining those who will get benefit from such therapy.

The relationship between epicardial adipose tissue and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

The relationship between epicardial adipose tissue (EAT) and coronary artery disease has been predominantly demonstrated in the last two decades. The aim of this study was to investigate the predictive value of EAT thickness on ST-segment resolution that reflects myocardial reperfusion in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, range 35-83, 15 women) with first acute STEMI who underwent successful pPCI. ST-segment resolution (ΔSTR) <70 % was accepted as ECG sign of no-reflow phenomenon. The EAT thickness was measured by two-dimensional echocardiography. EAT thickness was increased in patients with no-reflow (3.9 ± 1.7 vs. 5.4 ± 2, p = 0.001). EAT thickness was also found to be inversely correlated with ΔSTR (r = -0.414, p = 0.001). Multivariate logistic regression analysis demonstrated that EAT thickness independently predicted no-reflow (OR 1.43, 95 % CI 1.13-1.82, p = 0.003). Receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for EAT thickness in predicting no-reflow [area under curve (AUC) = 0.72, 95 % CI 0.63-0.82, p < 0.001]. In conclusion, increased EAT thickness may play an important role in the prediction of no-reflow in STEMI treated with pPCI.

The Relationship between Epicardial Adipose Tissue and ST-segment Resolution in Patients with Acute ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

The Relationship between Epicardial Adipose Tissue and ST-segment Resolution in Patients with Acute ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention