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Comparison of prognostic value of epicardial blood flow and early ST-segment resolution after primary coronary angioplasty. ANIN--Myocardial Infarction Registry.
Kardiol Pol. 2007 Jan; 65(1):1-10; discussion 11-2.KP

Abstract

BACKGROUND

TIMI scale is commonly used for angiographic assessment of reperfusion effectiveness and early risk stratification in patients treated with primary angioplasty for ST-elevation myocardial infarction (STEMI). Since ST-resolution analysis allows a noninvasive insight into the reperfusion status at the myocardial tissue level, it may be a better predictor of outcome after primary angioplasty.

AIM

To compare the prognostic value of the reperfusion effectiveness evaluation based on either the epicardial blood flow assessment according to the TIMI scale, or ST-segment resolution analysis in patients treated with primary coronary angioplasty for STEMI.

METHODS

324 consecutive patients treated within 12 hours from the pain onset were studied. Based on the analysis of maximal ST-segment elevation/depression identified in a single ECG lead recorded after the procedure (maxSTE), patients were classified into groups of high versus medium/low risk. Independently, distinguished were groups with restored normal (TIMI 3) and abnormal (TIMI 0-2) final blood flow in infarct related artery.

RESULTS

The 30-day and one-year mortality rates were higher in the high-risk maxSTE group (25% of all patients) than in the other patients (14.8% vs. 2.5%, p<0.001 and 18.5% vs. 5.4%, p<0.001 respectively). In subjects (82%) with restored TIMI grade 3 blood flow, mortality at one-month and one-year was lower than in the group with abnormal final blood flow (3.1% vs. 15.6%, p=0.001 and 6.2% vs. 18.8%, p=0.005). Comparison in multivariate analysis revealed that maxSTE stratification but not final TIMI grade assessment remained an independent predictor of both, 30-day and one-year mortality (high vs. medium/low-risk category; OR 5.3, 95% CI 1.6-16.7, p=0.005, and OR 3.3, 95% CI 1.4-7.8, p=0.007, respectively). Furthermore, maxSTE proved to stratify the risk of death even in subgroup of patients with restored normal blood flow (OR 6.2, 95% CI 1.4-27.8, p=0.016, and OR 3.0, 95% CI 1.1-8.7, p=0.039, respectively).

CONCLUSIONS

Analysis of extent of maximal ST-segment elevation or depression identified in a single ECG lead after primary coronary angioplasty allows better prognosis of subsequent 30-day and one-year mortality than the assessment of final epicardial blood flow, stratifying risk of death even in a subgroup of patients with restored normal blood flow.

Authors+Show Affiliations

I Klinika Choroby Wieńcowej i Samodzielna Pracownia Hemodynamiki, Instytut Kardiologii, Warszawa. lukasz.kalinczuk@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng pol

PubMed ID

17295155

Citation

Kalińczuk, Łukasz, et al. "Comparison of Prognostic Value of Epicardial Blood Flow and Early ST-segment Resolution After Primary Coronary Angioplasty. ANIN--Myocardial Infarction Registry." Kardiologia Polska, vol. 65, no. 1, 2007, pp. 1-10; discussion 11-2.
Kalińczuk Ł, Przyłuski J, Karcz M, et al. Comparison of prognostic value of epicardial blood flow and early ST-segment resolution after primary coronary angioplasty. ANIN--Myocardial Infarction Registry. Kardiol Pol. 2007;65(1):1-10; discussion 11-2.
Kalińczuk, Ł., Przyłuski, J., Karcz, M., Petryka, J., Kaczmarska, E., Bekta, P., Kepka, C., Kruk, M., Pregowski, J., Kadziela, J., Deptuch, T., Skwarek, M., Cedro, K., Ciszewski, M., Debski, A., Ciszewski, A., Chmielak, Z., Demkow, M., Witkowski, A., & Ruzyłło, W. (2007). Comparison of prognostic value of epicardial blood flow and early ST-segment resolution after primary coronary angioplasty. ANIN--Myocardial Infarction Registry. Kardiologia Polska, 65(1), 1-10; discussion 11-2.
Kalińczuk Ł, et al. Comparison of Prognostic Value of Epicardial Blood Flow and Early ST-segment Resolution After Primary Coronary Angioplasty. ANIN--Myocardial Infarction Registry. Kardiol Pol. 2007;65(1):1-10; discussion 11-2. PubMed PMID: 17295155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of prognostic value of epicardial blood flow and early ST-segment resolution after primary coronary angioplasty. ANIN--Myocardial Infarction Registry. AU - Kalińczuk,Łukasz, AU - Przyłuski,Jakub, AU - Karcz,Maciej, AU - Petryka,Joanna, AU - Kaczmarska,Edyta, AU - Bekta,Paweł, AU - Kepka,Cezary, AU - Kruk,Mariusz, AU - Pregowski,Jerzy, AU - Kadziela,Jacek, AU - Deptuch,Tomasz, AU - Skwarek,Mirosław, AU - Cedro,Krzysztof, AU - Ciszewski,Michał, AU - Debski,Artur, AU - Ciszewski,Andrzej, AU - Chmielak,Zbigniew, AU - Demkow,Marcin, AU - Witkowski,Adam, AU - Ruzyłło,Witold, PY - 2007/2/14/pubmed PY - 2007/7/18/medline PY - 2007/2/14/entrez SP - 1-10; discussion 11-2 JF - Kardiologia polska JO - Kardiol Pol VL - 65 IS - 1 N2 - BACKGROUND: TIMI scale is commonly used for angiographic assessment of reperfusion effectiveness and early risk stratification in patients treated with primary angioplasty for ST-elevation myocardial infarction (STEMI). Since ST-resolution analysis allows a noninvasive insight into the reperfusion status at the myocardial tissue level, it may be a better predictor of outcome after primary angioplasty. AIM: To compare the prognostic value of the reperfusion effectiveness evaluation based on either the epicardial blood flow assessment according to the TIMI scale, or ST-segment resolution analysis in patients treated with primary coronary angioplasty for STEMI. METHODS: 324 consecutive patients treated within 12 hours from the pain onset were studied. Based on the analysis of maximal ST-segment elevation/depression identified in a single ECG lead recorded after the procedure (maxSTE), patients were classified into groups of high versus medium/low risk. Independently, distinguished were groups with restored normal (TIMI 3) and abnormal (TIMI 0-2) final blood flow in infarct related artery. RESULTS: The 30-day and one-year mortality rates were higher in the high-risk maxSTE group (25% of all patients) than in the other patients (14.8% vs. 2.5%, p<0.001 and 18.5% vs. 5.4%, p<0.001 respectively). In subjects (82%) with restored TIMI grade 3 blood flow, mortality at one-month and one-year was lower than in the group with abnormal final blood flow (3.1% vs. 15.6%, p=0.001 and 6.2% vs. 18.8%, p=0.005). Comparison in multivariate analysis revealed that maxSTE stratification but not final TIMI grade assessment remained an independent predictor of both, 30-day and one-year mortality (high vs. medium/low-risk category; OR 5.3, 95% CI 1.6-16.7, p=0.005, and OR 3.3, 95% CI 1.4-7.8, p=0.007, respectively). Furthermore, maxSTE proved to stratify the risk of death even in subgroup of patients with restored normal blood flow (OR 6.2, 95% CI 1.4-27.8, p=0.016, and OR 3.0, 95% CI 1.1-8.7, p=0.039, respectively). CONCLUSIONS: Analysis of extent of maximal ST-segment elevation or depression identified in a single ECG lead after primary coronary angioplasty allows better prognosis of subsequent 30-day and one-year mortality than the assessment of final epicardial blood flow, stratifying risk of death even in a subgroup of patients with restored normal blood flow. SN - 0022-9032 UR - https://www.unboundmedicine.com/medline/citation/17295155/Comparison_of_prognostic_value_of_epicardial_blood_flow_and_early_ST_segment_resolution_after_primary_coronary_angioplasty__ANIN__Myocardial_Infarction_Registry_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -