title: ST peak during percutaneous coronary intervention serves as an early prognostic predictor in patients with ST-segment elevation myocardial.
abstract: OBJECTIVE
  To evaluate the clinical importance of the ST peak phenomenon during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  RESULTS
  Continuous ST monitoring was performed in 942 STEMI patients from arrival until 90 minutes after revascularisation. ST peak was defined as ≥1 mm increase in the ST-segment during PCI compared with the ST elevation before intervention. ST peak was observed in 26.9% of patients. During median follow-up of 4.1 years, 20.7% of patients experienced a major adverse cardiac event (MACE). ST peak was associated with higher rates of mortality (13.4% versus 9.3%; p=0.044), admission for heart failure (10.6% versus 5.2%; p=0.002) and MACE (26.9% versus 18.2%; p=0.002), but not reinfarction (7.1% versus 5.2%; p=0.14). In two different Cox regression analyses, adjusting for predictors of MACE and ST peak including ST resolution and epicardial flow, ST peak remained significantly associated with MACE: adjusted hazard ratio (HR) 1.40 (95% confidence interval [CI] 1.01-1.95) and 1.41 (95% CI: 1.02-1.96).
  
  
  CONCLUSIONS
  In the largest study hitherto evaluating the ST peak phenomenon during primary PCI, we demonstrated that ST peak is a strong predictor of adverse long-term outcome and provides independent prognostic information beyond that provided by ST resolution and epicardial flow.
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Lønborg
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.forename: Lene
authors.initials: L
authors.lastname: Kløvgaard
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.forename: Niels
authors.initials: N
authors.lastname: Vejlstrup
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamäki
authors.forename: Nadia P
authors.initials: NP
authors.lastname: Dridi
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.forename: Hans-Erik
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
mesh_terms: D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome