title: Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial.
abstract: OBJECTIVE
  This study was done to assess and compare the prognostic significance of multiple methods for measuring ST-segment elevation resolution (STR) following primary percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Resolution of ST-segment elevation (STE) is a powerful predictor of both infarct-related artery patency and mortality in acute myocardial infarction (AMI). Recent thrombolytic studies have suggested that simple measures of STR may be as powerful as more complex algorithms. The optimal method of assessing STR following primary PCI has not been studied.
  
  
  METHODS
  We analyzed 700 patients with technically adequate baseline and post-PCI electrocardiograms from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Five methods were used to assess STR: 1) summed %STR across multiple leads (SigmaSTR); 2) %STR in the single lead with maximum baseline STE (MaxSTR); 3) absolute maximum STE before the procedure; 4) absolute maximum STE after intervention (MaxSTPost); and 5) a categorical variable based upon MaxSTPost (High Risk).
  
  
  RESULTS
  At 30 days, SigmaSTR, MaxSTR, and MaxSTPost all correlated strongly with mortality (p = 0.004, p = 0.005, and p < 0.0001, respectively) and the combined end point of mortality or reinfarction (p = 0.001, p = 0.001, and p < 0.0001). At one year, SigmaSTR and MaxSTPost correlated with mortality (p = 0.04, p = 0.0001), reinfarction (p = 0.02, p = 0.0015), and the combined end point (p = 0.02, p < 0.0001). By multivariate analysis, only the simpler measures of MaxSTPost and High Risk categorization independently predicted all outcomes at both time points.
  
  
  CONCLUSIONS
  The STR following primary PCI in AMI correlates strongly with mortality and reinfarction, independent of target vessel patency. The simple measure of the maximal residual degree of STE after primary PCI is a strong independent predictor of both survival and freedom from reinfarction at 30 days and 1 year.
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: McLaughlin
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Eve
authors.initials: E
authors.lastname: Aymong
authors.forename: Graham
authors.initials: G
authors.lastname: Gardner
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: Thomas
authors.initials: T
authors.lastname: Stuckey
authors.forename: Eulogio
authors.initials: E
authors.lastname: Garcia
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Mark
authors.initials: M
authors.lastname: Turco
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome