Risk stratification in ST-elevation myocardial infarction is enhanced by combining baseline ST deviation and subsequent ST-segment resolution.
BACKGROUND
The baseline sum of ST deviation (SigmaSTD) and ST segment resolution after fibrinolysis for ST-elevation myocardial infarction are prognostically useful.


OBJECTIVE
To examine the prognostic impact of ST resolution after fibrinolysis and influence of baseline ST deviation in ASSENT-3.


METHODS
ST resolution was determined in 4565 patients at 180 minutes after fibrinolysis. 30-Day and 1-year mortality was assessed in patients with complete (ie, > or =50%) versus incomplete ST resolution according to absolute baseline SigmaSTD.


RESULTS
Patients with complete ST resolution had lower 30-day and 1-year mortality than those with incomplete ST resolution (3.7% vs 7.3%, p<0.001, and 6.1% vs 10.0%, p<0.001, respectively). After multivariable adjustment for key baseline risk factors, patients with anterior myocardial infarction (MI) in the highest quartile of SigmaSTD had a greater risk of 30-day and 1-year mortality than those in the lowest quartile in both complete (odds ratio (OR) = 2.34, 95% CI 1.14 to 4.80, and OR = 2.34, 95% CI 1.26 to 4.34, respectively) and incomplete ST resolution groups (OR = 4.97, 95% CI 1.82 to 13.61, and OR = 3.61, 95% CI 1.55 to 8.4, respectively). However, in patients with inferior MI this pattern only existed when ST resolution was incomplete (OR = 4.88, 95% CI 1.65 to 14.39, and OR = 4.34, 95% CI 1.66 to 11.37, respectively).


CONCLUSIONS
These findings indicate that percentage ST resolution alone is an incomplete guide to 30-day and 1-year mortality. The integration of both the baseline and post-fibrinolysis ECG provides better risk assessment and can assist in the triage and treatment of such patients.
Toma
M
M
University of Alberta, Edmonton, Canada.
Fu
Y
Y
Wagner
G
G
Goodman
S G
SG
Granger
C
C
Wallentin
L
L
Van de Werf
F
F
Armstrong
P
P
D003328:Coronary Thrombosis / Q000517:prevention & control; D004562:Electrocardiography / Q000379:methods; D004812:Epidemiologic Methods; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents