title: Pre-angiography total ST-segment resolution is not a reliable predictor of an open infarct-related artery.
abstract: BACKGROUND
  While the cutoffs of predictive value for ST-segment elevations resolution (STSR) following thrombolysis and/or primary PCI were well documented, the impact of pre-angiography STSR has not been established yet.
  
  
  OBJECTIVE
  The aim of this study is to assess prognostic utility of pre-angiography STSR to predict pre-procedural TIMI flow in the infarct-related artery (IRA) and infarct size in STEMI patients undergoing primary PCI.
  
  
  METHODS
  A prospective study was performed, including 310 patients, admitted within 12h of symptom onset and who underwent primary PCI. ST-segment elevations were measured in: (1) qualifying ECG, (2) ECG before angiography, and (3) ECG post PCI. STSR was defined as: total (≥70%), partial (between 70% and 30%) and none (<30%). Relationships between pre-angiography STSR, initial TIMI flow and troponin T level (TnT) were analyzed.
  
  
  RESULTS
  Pre-angiography STSR correlated with initial TIMI flow in the IRA (rS=0.619; p<0.001). Pre-angiography total STSR was observed in 23.2% patients. It was noted in 79.2% of patients with pre-procedural TIMI flow ≥2 and in 20.8% with TIMI flow ≤1 (p<0.001). Although the sensitivity of pre-angiography total STSR to detect pre-procedural TIMI flow ≥2 was 93%, its specificity was only 56% and the likelihood ratio was 2.1. Pre-angiography total STSR was associated with lower peak TnT level (2.2±2.5ng/ml vs. 6.4±5.0ng/ml, p<0.0001) when compared to the remaining patients.
  
  
  CONCLUSIONS
  1. Pre-angiography STSR correlates with preprocedural TIMI flow. 2. The sensitivity of pre-angiography total STSR in detection of pre-procedural TIMI flow ≥2 is high, but low specificity of only 56% makes it an unreliable predictor of an open IRA.
authors.affiliation: Department of Invasive Cardiology, Kiepury 45, 64-100 Leszno, Poland; I(st) Department of Cardiology, Poznan University of Medical Sciences, Dluga ½, 61-848 Poznan, Poland. Electronic address: mmprech@wp.pl.
authors.forename: Marek
authors.initials: M
authors.lastname: Prech
authors.affiliation: Department of Invasive Cardiology, Kiepury 45, 64-100 Leszno, Poland. Electronic address: ebartela@o2.pl.
authors.forename: Ewa
authors.initials: E
authors.lastname: Bartela
authors.affiliation: I(st) Department of Cardiology, Poznan University of Medical Sciences, Dluga ½, 61-848 Poznan, Poland. Electronic address: aaraszkiewicz@interia.pl.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Araszkiewicz
authors.affiliation: I(st) Department of Cardiology, Poznan University of Medical Sciences, Dluga ½, 61-848 Poznan, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Janus
authors.affiliation: I(st) Department of Cardiology, Poznan University of Medical Sciences, Dluga ½, 61-848 Poznan, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Kutrowska
authors.affiliation: I(st) Department of Cardiology, Poznan University of Medical Sciences, Dluga ½, 61-848 Poznan, Poland.
authors.forename: Lidia
authors.initials: L
authors.lastname: Urbanska
authors.affiliation: I(st) Department of Cardiology, Poznan University of Medical Sciences, Dluga ½, 61-848 Poznan, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Pyda
authors.affiliation: I(st) Department of Cardiology, Poznan University of Medical Sciences, Dluga ½, 61-848 Poznan, Poland. Electronic address: stefan.grajek@sk1.am.poznan.pl.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grajek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: Percutaneous coronary intervention; Pre-angiography ST-segment resolution; TIMI flow