Resolution of ST-segment depression: a new prognostic marker in ST-segment elevation myocardial infarction EUROPEAN HEART JOURNAL Tjandrawidjaja, M. C., Fu, Y., Westerhout, C. M., White, H. D., Todaro, T. G., Van de Werf, F., Mahaffey, K. W., Wagner, G. S., Granger, C. B., Armstrong, P. W. 2010; 31 (5): 573-581


To evaluate the prognostic impact of ST depression resolution among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial.In this study, 4729 of 5745 patients had analysable ECGs demonstrating concomitant ST-segment depression. Resolution of summation operatorST elevation (STE-R) and summation operatorST depression (STD-R) on 30 min post-PCI ECGs was dichotomized into those with > or =50 vs. <50% ST-segment resolution. Overall, 1143 patients (24%) had STD-R<50%. These patients had higher risk characteristics including older age, female sex, diabetes, hypertension, prior CHF/MI, Killip class >I, triple vessel disease, and less frequent TIMI 3 flow in the culprit coronary vessel post-PCI. After multivariable adjustment and accounting for STE-R, STD-R<50% remained an independent predictor for 90 day death and the composite of death, cardiogenic shock, or CHF. When compared with patients with both STE-R and STD-R> or =50%, patients with both STE-R and STD-R<50% had the worst outcomes [hazard ratios (HR) 90 day death: 2.54; 95% confidence intervals (CI): 1.71-3.77; HR 90 day composite: 2.18; 95% CI: 1.63-2.91].When ST depression is present in STEMI patients undergoing primary PCI, STD-R<50% provides independent prognostic value that is incremental to STE-R.

View details for DOI 10.1093/eurheartj/ehp494

View details for Web of Science ID 000275241900015

View details for PubMedID 19952006