title: Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours.
abstract: Primary percutaneous coronary intervention (pPCI) is recommended in patients with ST Elevation Myocardial Infarction (STEMI) and symptom duration <12hours. However, a considerable amount of myocardium might still be salvaged in STEMI patients with symptom durations >12hours (late-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters.
  
  
  
  The AW-score (range 1-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage potential (MSI) according to AW-score ≥3 (acute ischemia) and AW-score <3 (late ischemia).
  
  
  
  Late-presenters had median MSI 53% (inter quartile range (IQR) 27-89). The AW-score strongly correlated with MSI (β=0.60, R(2)=0.36, p<0.0001), while pain-to-balloon time did not (β=-0.21, R(2)=0.04, p=0.14). Patients with AW-score ≥3 (n=16) compared to those with AW-score <3 (n=27) had significant larger MSI (82.7% vs 41.5%, p=0.014). MSI>median was observed in 79% in patients with AW-score ≥3 vs 32% in patients with AW-score <3 (adjusted OR 6.74 [95% CI 1.35-33.69], p=0.02).
  
  
  
  AW-score was strongly associated with myocardial salvage while pain-to-balloon time was not. STEMI patients with symptom duration between 12 -72hours and AW-score ≥3 achieved substantial salvage after pPCI.
authors.affiliation: Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark; Department of Medicine, Division of Cardiology, Nykøbing F University Hospital, Nykøbing F, Denmark. Electronic address: yfakhri@gmail.com.
authors.forename: Yama
authors.initials: Y
authors.lastname: Fakhri
authors.affiliation: Department of Cardiology, Vejle Hospital, Vejle, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Busk
authors.affiliation: Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.
authors.forename: Mikkel Malby
authors.initials: MM
authors.lastname: Schoos
authors.affiliation: Zealand University Hospital, Denmark.
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
authors.forename: Steen D
authors.initials: SD
authors.lastname: Kristensen
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.affiliation: Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.
authors.forename: Maria
authors.initials: M
authors.lastname: Sejersten
authors.affiliation: Department of Medicine, Division of Cardiology, Nykøbing F University Hospital, Nykøbing F, Denmark; Department of Medicine, Division of Cardiology, Nykøbing F Hospital, Nykøbing F and University of Southern Denmark, Odense, Denmark; University Clinic Hamburg-Eppendorf, The Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.affiliation: Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
mesh_terms: D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention; D011300:Preoperative Care; D011379:Prognosis; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016879:Salvage Therapy / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D063189:Symptom Assessment; D016896:Treatment Outcome
keywords: Ischemia; Late presentation; Prehospital ECG; STEMI