Clinical Predictors of Incomplete ST-Segment Resolution in the Patients With Acute ST Segment Elevation Myocardial Infarction.
10.4070/kcj.2009.39.8.310
- Author:
So Ra PARK
1
;
Young Ran KANG
;
Myeng Ki SEO
;
Min Kyeng KANG
;
Jong Hyen CHO
;
Yon Jung AN
;
Chung Hwan KWAK
;
Sek Jae HWANG
;
Young Hun JUNG
;
Jin Yong HWANG
Author Information
1. Department of Internal Medicine, Gyeongsang Institute of Health, School of Medicine, Gyeongsang National University, Jinju, Korea. jyhwang@gnu.ac.kr
- Publication Type:Original Article
- Keywords:
Myocardial infarction;
Coronary circulation;
Electrocardiography
- MeSH:
Arteries;
Chest Pain;
Coronary Angiography;
Coronary Circulation;
Electrocardiography;
Female;
Humans;
Infarction;
Ischemia;
Logistic Models;
Male;
Myocardial Infarction;
Natriuretic Peptide, Brain;
Percutaneous Coronary Intervention;
Phosphotransferases;
Troponin I
- From:Korean Circulation Journal
2009;39(8):310-316
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND OBJECTIVES: The failure of ST-segment resolution (STR) after primary percutaneous coronary intervention (pPCI) is associated with adverse clinical outcomes. However, the clinical predictors on admission for incomplete STR are poorly known. SUBJECTS AND METHODS: Patients undergoing pPCI (n=101, 79 males and 22 females, mean age 60.0 years) were divided into complete STR group (> or =70%, n=58) and incomplete STR group (<70%, n=43). The groups were compared according to clinical factors including history, electrocardiographic (ECG) patterns, angiographic features and laboratory data. RESULTS: The incomplete STR group contained more frequent hypertensive patients (p=0.04) and patients displaying longer tendency in total chest pain duration (p=0.08). This group was associated with worse clinical factors such as low ejection fraction (p=0.06), higher Killip class (p=0.08) and more death (p=0.042). Grade 3 ischemia pattern of ECG and precordial ST elevation (i,e anterior myocardial infarction) at admission were more frequent in the incomplete STR group (p=0.001 and 0.002, respectively). Initial troponin I, creatinin kinase -MB and brain natriuretic peptide levels were higher in the incomplete STR group (p=0.001, 0.002, and 0.043, respectively). Coronary angiography showed that culprit lesions were more frequent in left anterior descending artery than other arteries in the incomplete STR group of patients (p=0.002). Thrombolysis In Myocardial Infarction (TIMI) flow grades 2 or less before PCI was more frequent in the incomplete STR group (p=0.029). However, TIMI flow grade after PCI was not appreciably different between the two groups. Logistic regression analysis demonstrated that TIMI flow grade 2 or less was most powerful predictor for incomplete STR {odds ratio (OR)=12.12, 95% confidence interval (CI) 1.23-119.35, p=0.032}. Other independent predictors were anterior infarction (OR=3.39, CI 1.46-10.57, p=0.007), ischemia grade 3 ECG at admission (OR=3.87, CI 1.31-11.41, p=0.014), and hypertensive patients (OR=3.03, CI 1.13-8.15, p=0.027). CONCLUSION: Incomplete STR after pPCI is associated with poor prognostic clinical factors. TIMI flow grade 2 or less before pPCI, ST elevation on precordial leads, ischemia grade 3 pattern of initial ECG, and hypertensive patients are independent predictors for incomplete STR in the early stage.
