title: Comparison of different methods of ST segment resolution analysis for prediction of 1-year mortality after primary angioplasty for acute myocardial infarction.
abstract: BACKGROUND
  Resolution of ST segment elevation corresponds with myocardial tissue reperfusion and correlates with clinical outcome after ST elevation myocardial infarction. Simpler method evaluating the extent of maximal deviation persisting in a single ECG lead was an even stronger mortality predictor. Our aim was to evaluate and compare prognostic accuracy of different methods of ST segment elevation resolution analysis after primary percutaneous coronary intervention (PCI) in a real-life setting.
  
  
  METHODS
  Paired 12-lead ECGs were analyzed in 324 consecutive and unselected patients treated routinely with primary PCI in a single high-volume center. ST segment resolution was quantified and categorized into complete, partial, or none, upon the (1) sum of multilead ST elevations (sumSTE) and (2) sum of ST elevations plus reciprocal depressions (sumSTE+D); or into the low-, medium-, and high-risk groups by (3) the single-lead extent of maximal postprocedural ST deviation (maxSTE).
  
  
  RESULTS
  Complete, partial, and nonresolution groups by sumSTE constituted 39%, 40%, and 21% of patients, respective groups by sumSTE+D comprised 40%, 39%, and 21%. The low-, medium-, and high-risk groups constituted 43%, 32%, and 25%. One-year mortality rates for rising risk groups by sumSTE were 4.7%, 10.2%, and 14.5% (P = 0.049), for sumSTE+D 3.8%, 9.6%, and 17.6% (P = 0.004) and for maxSTE 5.1%, 6.7%, and 18.5% (P = 0.001), respectively. After adjustment for multiple covariates only maxSTE (high vs low-risk, odds ratio [OR] 3.10; 95% confidence interval [CI] 1.11-8.63; P = 0.030) and age (OR 1.07; 95% CI 1.02-1.11; P = 0.002) remained independent predictors of mortality.
  
  
  CONCLUSIONS
  In unselected population risk stratifications based on the postprocedural ST resolution analysis correlate with 1-year mortality after primary PCI. However, only the single-lead ST deviation analysis allows an independent mortality prediction.
authors.affiliation: Coronary Disease Department and II Haemodynamic Department, Institute of Cardiology, 42 Alpejska Street, 04-628 Warsaw-Anin, Poland. jprzyluski@ikard.pl
authors.forename: Jakub
authors.initials: J
authors.lastname: Przyluski
authors.forename: Maciej
authors.initials: M
authors.lastname: Karcz
authors.forename: Lukasz
authors.initials: L
authors.lastname: Kalińczuk
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.forename: Jerzy
authors.initials: J
authors.lastname: Pregowski
authors.forename: Edyta
authors.initials: E
authors.lastname: Kaczmarska
authors.forename: Joanna
authors.initials: J
authors.lastname: Petryka
authors.forename: Paweł
authors.initials: P
authors.lastname: Bekta
authors.forename: Tomasz
authors.initials: T
authors.lastname: Deptuch
authors.forename: Cezary
authors.initials: C
authors.lastname: Kepka
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors