Relationship Between ST-Segment Recovery and Clinical Outcomes After Primary Percutaneous Coronary Intervention: The HORIZONS-AMI ECG Substudy Report.

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Relationship Between ST-Segment Recovery and Clinical Outcomes After Primary Percutaneous Coronary Intervention: The HORIZONS-AMI ECG Substudy Report.

Circ Cardiovasc Interv. 2013 May 7;

Authors: Farkouh ME, Reiffel J, Dressler O, Nikolsky E, Parise H, Cristea E, Baran DA, Dizon J, Merab JP, Lansky AJ, Mehran R, Stone GW

Abstract

BACKGROUND: IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDERGOING THROMBOLYTIC THERAPY, THE DEGREE OF ST-SEGMENT RESOLUTION (STR) CORRELATES WITH LONG-TERM CARDIOVASCULAR MORTALITY. THE LONG-TERM PREDICTIVE VALUE OF STR AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION (PCI) IS LESS WELL UNDERSTOOD. WE SOUGHT TO DETERMINE THE LONG-TERM PROGNOSTIC VALUE OF STR AFTER PRIMARY PCI IN ST-SEGMENTELEVATION MYOCARDIAL INFARCTION.METHODS AND RESULTS: IN A FORMAL SUBSTUDY FROM THE HARMONIZING OUTCOMES WITH REVASCULARIZATION AND STENTS IN ACUTE MYOCARDIAL INFARCTION (HORIZONS-AMI) TRIAL, 2484 PATIENTS WITH ST-SEGMENTELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PCI WITH INTERPRETABLE BASELINE AND 60-MINUTE POST-PCI ELECTROCARDIOGRAMS HAD AT LEAST 1 MM OF BASELINE ST-SEGMENT ELEVATION IN 2 CONTIGUOUS LEADS. PATIENTS WERE CATEGORIZED BY THE DEGREE OF STR AT 60 MINUTES: (1) COMPLETE (70%); (2) PARTIAL (30%70%); AND (3) ABSENT (30%). ABSENT, INCOMPLETE, AND COMPLETE STR WERE ACHIEVED IN 514 (20.7%), 712 (28.7%), AND 1258 (50.5%) PATIENTS, RESPECTIVELY. STR 30% WAS ASSOCIATED WITH A GREATER LIKELIHOOD OF HYPERTENSION, DIABETES MELLITUS, LONGER SYMPTOM ONSET TO BALLOON TIME, LOWER LEFT VENTRICULAR EJECTION FRACTION, AND FINAL THROMBOLYSIS IN MYOCARDIAL INFARCTION FLOW 3. AT 3 YEARS, PATIENTS WITH STR30% EXPERIENCED A HIGHER RATE OF MAJOR ADVERSE CARDIOVASCULAR EVENTS (DEATH, REINFARCTION, ISCHEMIA-DRIVEN TARGET VESSEL REVASCULARIZATION OR STROKE; 29.9% VERSUS 20.1% VERSUS 19.6%; P0.0001), ISCHEMIA-DRIVEN TARGET VESSEL REVASCULARIZATION (20.4% VERSUS 14.0% VERSUS 11.7%; P0.001), AND MORTALITY (8.4% VERSUS 5.0% VERSUS 5.6%; P=0.03) THAN THOSE WITH PARTIAL AND COMPLETE STR, RESPECTIVELY. BY MULTIVARIABLE ANALYSIS, STR30% WAS AN INDEPENDENT PREDICTOR OF 3-YEAR MAJOR ADVERSE CARDIOVASCULAR EVENTS (HAZARD RATIO, 1.58; 95% CONFIDENCE INTERVAL, 1.242.00; P=0.0002) AND 3-YEAR ISCHEMIA-DRIVEN TARGET VESSEL REVASCULARIZATION (HAZARD RATIO, 1.87; 95% CONFIDENCE INTERVAL, 1.412.48; P0.0001).CONCLUSIONS: IN THIS LARGE INTERNATIONAL STUDY, ABSENT STR 60 MINUTES AFTER PRIMARY PCI WAS PRESENT IN 1 IN 5 PATIENTS WITH ST-SEGMENTELEVATION MYOCARDIAL INFARCTION AND WAS A SIGNIFICANT INDEPENDENT PREDICTOR OF MAJOR ADVERSE CARDIOVASCULAR EVENTS AND TARGET VESSEL REVASCULARIZATION AT 3 YEARS.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.

PMID: 23652600 [PubMed - as supplied by publisher]

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