title: Combined Assessments of Biochemical Markers and ST-Segment Resolution Provide Additional Prognostic Information for Patients With ST-Segment Elevation Myocardial Infarction.
abstract: OBJECTIVE
  The prognostic value of biochemical markers and the resolution of ST-segment elevation on electrocardiogram are well established. However, how a combination of these two tools affects the evaluation of risk stratification has not yet been evaluated.
  
  
  METHODS
  Between January 2006 and June 2008, 178 consecutive patients treated with primary percutaneous coronary interventions after ST-segment elevation myocardial infarctions (STEMI) were analyzed at two coronary care units. Patients were divided into the following three groups according to ST-segment resolution: complete (≥70% depression of the elevated ST-segment, n=63), partial (30% to 70%, n=90), and incomplete (<30%, n=25). Demographic data, including history, electrocardiography, biochemical markers, initial ejection fraction, and angiographic findings were also evaluated.
  
  
  RESULTS
  There were 7 deaths, 3 repeated myocardial infarctions, and 17 readmissions for worsening heart failure during six months of follow-up. In a multivariate analysis to predict clinical outcomes, ejection fraction {hazard ratio (HR): 0.83 (0.76-0.91), p<0.01}, high-sensitivity C-reactive protein {HR: 1.15 (1.05-1.26), p<0.05}, and the degree of ST-segment resolution {HR: 0.96 (0.93-0.09), p<0.05} were independently associated with clinical outcomes. According to the Cox-proportional hazards model, the addition of ST-segment resolution markedly improved the prognostic utility of the model containing biochemical markers and ejection fraction.
  
  
  CONCLUSIONS
  Assessment of biomarkers upon admission and ST-segment resolution are strong predictors of clinical outcomes. The combination of these data provides additive information about prognosis at an early point in the disease progression and further improves risk stratification for STEMI.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Jong Shin
authors.initials: JS
authors.lastname: Woo
authors.forename: Jin Man
authors.initials: JM
authors.lastname: Cho
authors.forename: Soo Joong
authors.initials: SJ
authors.lastname: Kim
authors.forename: Myeong Kon
authors.initials: MK
authors.lastname: Kim
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim