Format

Send to

Choose Destination
Heart. 2016 Apr;102(7):527-33. doi: 10.1136/heartjnl-2015-308075. Epub 2016 Jan 18.

Implications of ischaemic area at risk and mode of reperfusion in ST-elevation myocardial infarction.

Author information

1
Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
2
Department of Cardiothoracic Sciences, Azienda Ospedaliero Universitaria di Udine, Udine, Italy.
3
Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway.
4
Cardiology Division, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.
5
Medical School, University of Belgrade, Belgrade, Serbia.
6
Emergency Department and Service d'aide Medicale Urgente (SAMU), Lille University Hospital, Lille, France.
7
Leicester Cardiovascular Biomedical Research Unit, National Institute for Health Research, University Hospitals of Leicester Trust, Leicester, UK.
8
Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.

Abstract

OBJECTIVE:

Uncertainty exists concerning the relative merits of pharmacological versus mechanical coronary reperfusion in patients presenting early with ST-elevation myocardial infarction (STEMI) with extensive myocardium at risk. Accordingly, we investigated whether the extent of baseline ST-segment shift was related to the response of either reperfusion modality in patients with STEMI presenting within 3 h of symptoms.

METHODS:

We analysed baseline ECGs from 1859 patients enrolled in the STrategic Reperfusion Early After Myocardial Infarction (STREAM) trial. The sum of ST-segment elevation (∑STE) and ST-segment deviation (∑STD) was categorised into quartiles and associations with the primary endpoint (30-day death/shock/congestive heart failure/re-myocardial infarction) for each reperfusion strategy (early fibrinolysis vs primary percutaneous coronary intervention) were explored.

RESULTS:

Overall, there was a progressive rise in the 30-day primary endpoint according to quartiles of baseline ∑STE (10.3% (0-5 mm), 12.4% (5.5-8.5 mm), 12.1% (9-13.5 mm), 17.6% (> 14.0 mm), p = 0.008) and ∑STD (9.0% (0-9 mm), 13.5% (9.5-14 mm), 14.7% (14.5-20 mm), 15.3% (> 20 mm), p = 0.019). Both ∑STE and ∑STD were associated with the primary endpoint (∑STE: p = 0.071; ∑STD: p = 0.024). However, there was no interaction between quartiles of baseline ∑STE or ∑STD and efficacy of either reperfusion strategy on the 30-day clinical outcomes (∑STE: p (interaction) = 0.696; ∑STD: p (interaction) = 0.542).

CONCLUSIONS:

These data demonstrate an association between ∑STE or ∑STD on the baseline ECG and clinical events at 30 days following reperfusion therapy in STEMI. More importantly, the response to different reperfusion strategies was not influenced by the extent of jeopardised myocardium.

TRIAL REGISTRATION NUMBER:

NCT00623623; Post-results.

PMID:
26783237
DOI:
10.1136/heartjnl-2015-308075
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center