title: Implications of ischaemic area at risk and mode of reperfusion in ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Uncertainty exists concerning the relative merits of pharmacological versus mechanical coronary reperfusion in patients presenting early with ST-elevation myocardial infarction (STEMI) with extensive myocardium at risk. Accordingly, we investigated whether the extent of baseline ST-segment shift was related to the response of either reperfusion modality in patients with STEMI presenting within 3 h of symptoms.
  
  
  METHODS
  We analysed baseline ECGs from 1859 patients enrolled in the STrategic Reperfusion Early After Myocardial Infarction (STREAM) trial. The sum of ST-segment elevation (∑STE) and ST-segment deviation (∑STD) was categorised into quartiles and associations with the primary endpoint (30-day death/shock/congestive heart failure/re-myocardial infarction) for each reperfusion strategy (early fibrinolysis vs primary percutaneous coronary intervention) were explored.
  
  
  RESULTS
  Overall, there was a progressive rise in the 30-day primary endpoint according to quartiles of baseline ∑STE (10.3% (0-5 mm), 12.4% (5.5-8.5 mm), 12.1% (9-13.5 mm), 17.6% (> 14.0 mm), p = 0.008) and ∑STD (9.0% (0-9 mm), 13.5% (9.5-14 mm), 14.7% (14.5-20 mm), 15.3% (> 20 mm), p = 0.019). Both ∑STE and ∑STD were associated with the primary endpoint (∑STE: p = 0.071; ∑STD: p = 0.024). However, there was no interaction between quartiles of baseline ∑STE or ∑STD and efficacy of either reperfusion strategy on the 30-day clinical outcomes (∑STE: p (interaction) = 0.696; ∑STD: p (interaction) = 0.542).
  
  
  CONCLUSIONS
  These data demonstrate an association between ∑STE or ∑STD on the baseline ECG and clinical events at 30 days following reperfusion therapy in STEMI. More importantly, the response to different reperfusion strategies was not influenced by the extent of jeopardised myocardium.
  
  
  BACKGROUND
  NCT00623623; Post-results.
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Bainey
authors.affiliation: Department of Cardiothoracic Sciences, Azienda Ospedaliero Universitaria di Udine, Udine, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Fresco
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Yinggan
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway.
authors.forename: Sigrun
authors.initials: S
authors.lastname: Halvorsen
authors.affiliation: Cardiology Division, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carvalho
authors.affiliation: Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojic
authors.affiliation: Emergency Department and Service d'aide Medicale Urgente (SAMU), Lille University Hospital, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goldstein
authors.affiliation: Leicester Cardiovascular Biomedical Research Unit, National Institute for Health Research, University Hospitals of Leicester Trust, Leicester, UK.
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Gershlick
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Westerhout
authors.affiliation: Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.affiliation: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D057186:Comparative Effectiveness Research; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000379:methods; D063868:Patient Outcome Assessment; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D017984:Enoxaparin; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine