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Maletin S, Petrović M, Stojšić-Milosavljević A, Miljković T, Milovančev A, Petrović I, Milosavljević I, Balenović A, Čanković M. The Role of QRS Complex and ST-Segment in Major Adverse Cardiovascular Events Prediction in Patients with ST Elevated Myocardial Infarction: A 6-Year Follow-Up Study. Diagnostics (Basel) 2024; 14:1042. [PMID: 38786340 PMCID: PMC11120035 DOI: 10.3390/diagnostics14101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND as a relatively high number of ST-segment elevation myocardial infarction (STEMI) patients develop major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI), our aim was to determine the significance, and possible predictive value of QRS complex width and ST-segment elevation. METHODS our patient sample included 200 PCI-treated STEMI patients, which were divided into two groups based on the following duration of symptoms: (I) less than 6 h, and (II) 6 to 12 h. For every patient, an ECG was performed at six different time points, patients were followed for up to six years for the occurrence of MACE. RESULTS the mean age was 60.6 ± 11.39 years, and 142 (71%) were male. The 6-12 h group had significantly wider QRS complex, higher ST-segment elevation, lower prevalence of ST-segment resolution as well as MACE prevalence (p < 0.05). ECG parameters, QRS width, and magnitude of ST-segment elevation were proved to be independent significant predictors of MACE in all measured time points (p < 0.05). Even after controlling for biomarkers of myocardial injury, these ECG parameters remained statistically significant predictors of MACE (p < 0.05). CONCLUSION our study highlights that wider QRS complex and a more pronounced ST-segment elevation are associated with longer total ischemic time and higher risk of long-term MACE.
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Affiliation(s)
- Srđan Maletin
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Milovan Petrović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Anastazija Stojšić-Milosavljević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Ivan Petrović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
| | - Isidora Milosavljević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
| | - Ana Balenović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
| | - Milenko Čanković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.M.); (M.P.); (A.S.-M.); (T.M.); (A.M.); (I.P.); (I.M.); (A.B.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
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Cimino S, Pighi M. Prognostic value of ST-segment monitoring after primary percutaneous coronary intervention: still an issue? Minerva Cardiol Angiol 2021; 69:130-132. [PMID: 33929137 DOI: 10.23736/s2724-5683.20.05335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sara Cimino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy -
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Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:373-382. [PMID: 30603027 PMCID: PMC6309837 DOI: 10.5114/aic.2018.79867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction The study aimed to evaluate the prevalence and predictors of left ventricular (LV) reverse remodeling and its impact on long-term prognosis in patients with anterior ST-segment elevation myocardial infarction (STEMI). Aim To assess the percentage of reverse remodeling and its prognostic factors in anterior STEMI patients. Material and methods This observational study included 40 patients with first ever STEMI of the anterior wall. LV reverse remodeling was defined as the reduction of left ventricular end-systolic volume (ΔLVESV) by ≥ 10% in 3D transthoracic echocardiography (3D-TTE) at 3-month follow-up. 3D-TTE and speckle tracking imaging were performed during index hospitalization, while 3D-TTE and cardiac magnetic resonance (CMR) were performed at 3 months following the procedure. Patients were followed up for a median time of 3.4 years in order to evaluate major adverse cardiovascular events. Results Left ventricular reverse remodeling at 3-month follow-up was confirmed in 15 (37.5%) patients. The presence of reverse remodeling was predicted by lower troponin levels (unit OR = 0.86, p = 0.02), lower sum of ST-segment elevations before (unit OR = 0.87, p = 0.03) and after PCI (unit OR = 0.40, p = 0.03), lower maximal ST-segment elevation after PCI (unit OR = 0.01, p = 0.03), lower wall motion score index (unit OR 0.40, p = 0.03) and more negative anterior wall global longitudinal strain (unit OR = 0.88, p = 0.045). Nine MACE were reported in the without reverse remodeling group only. Non-significantly better event-free survival in the reverse remodeling group was demonstrated (log-rank p = 0.07). Conclusions Development of reverse modeling in patients with optimal revascularization and tailored pharmacotherapy is relatively high. Further studies are warranted in order to adjudicate its prognostic role for the prediction of adverse events.
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Karamasis GV, Russhard P, Al Janabi F, Parker M, Davies JR, Keeble TR, Clesham GJ. Peri-procedural ST segment resolution during Primary Percutaneous Coronary Intervention (PPCI) for acute myocardial infarction: predictors and clinical consequences. J Electrocardiol 2017; 51:224-229. [PMID: 29108788 DOI: 10.1016/j.jelectrocard.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE ECG ST segment resolution (STR) has been used to assess myocardial perfusion in STEMI patients undergoing PPCI. However, in most of the studies ECGs recorded at different time points after the actual procedure have been used, limiting the options of therapeutic interventions while the patient is still in the catheterisation laboratory. The aim of this study was to investigate the presence and clinical consequences of intra-procedural STR during PPCI. METHODS We analysed 12 lead ECGs recorded at the onset and the end of the PPCI procedure, measuring STR in the lead with maximum ST elevation on the initial recording. STR was defined as good when > 50% compared to baseline. RESULTS Pre and immediately post PPCI ECGs were recorded in 467 STEMI cases whilst the patient was on the catheter lab table. Mean patient age was 63 (+/- 12) years old and 75% were men. Mean duration of symptoms to admission was 3.8 (+/- 3.4) hours and 51% of infarcts were anterior. Good ST resolution at the end of the procedure was seen in 46.5% of patients and was observed more commonly in inferior compared to anterior infarcts (60.1% vs. 32.6%, p<0.001), and in current smokers (53.2% vs. 42.4%, p=0.031). In patients presenting with symptoms for < 4 hours, good STR was more common (74% vs. 66%, p=0.019). Thrombus aspiration was used more frequently in patients who had good STR (88.5% vs 79.8% p=0.011). Patients with good ST resolution had a shorter mean hospital length of stay (3.8 vs. 4.5 days, p=0.009) and a higher left ventricular ejection fraction (49.9% vs. 44.2%, p<0.001) measured by transthoracic echocardiography prior to discharge. CONCLUSION Good peri-procedural ST resolution was seen in less than half of STEMI patients undergoing PPCI. There were important clinical consequences of good ST resolution. Identification of suboptimal peri-procedural ST resolution could help identify patients who may benefit from new treatments aimed at protecting the microcirculation, whilst the patients are still in the angiography laboratory.
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Affiliation(s)
- Grigoris V Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Paul Russhard
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK
| | - Firas Al Janabi
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Michael Parker
- Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - John R Davies
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Gerald J Clesham
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK.
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Cuenin L, Lamoureux S, Schaaf M, Bochaton T, Monassier JP, Claeys MJ, Rioufol G, Finet G, Garcia-Dorado D, Angoulvant D, Elbaz M, Delarche N, Coste P, Metge M, Perret T, Motreff P, Bonnefoy-Cudraz E, Vanzetto G, Morel O, Boussaha I, Ovize M, Mewton N. Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction - Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year. Circ J 2017; 82:1379-1386. [PMID: 28943533 DOI: 10.1253/circj.cj-17-0671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance.Methods and Results:A standard 12-lead electrocardiogram (ECG) was recorded in 662 patients with anterior STEMI referred for primary percutaneous coronary intervention (PPCI). ECGs were recorded 60-90 min after PPCI and at discharge. ST segment re-elevation was defined as a ≥0.1-mV increase in STMax between the post-PPCI and discharge ECGs. Infarct size (assessed as creatine kinase [CK] peak), echocardiography at baseline and follow-up, and all-cause death and heart failure events at 1 year were assessed. In all, 128 patients (19%) had ST segment re-elevation. There was no difference between patients with and without re-elevation in infarct size (CK peak [mean±SD] 4,231±2,656 vs. 3,993±2,819 IU/L; P=0.402), left ventricular (LV) ejection fraction (50.7±11.6% vs. 52.2±10.8%; P=0.186), LV adverse remodeling (20.1±38.9% vs. 18.3±30.9%; P=0.631), or all-cause mortality and heart failure events (22 [19.8%] vs. 106 [19.2%]; P=0.887) at 1 year. CONCLUSIONS Among anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size or major adverse events at 1 year.
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Affiliation(s)
- Léo Cuenin
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | - Mathieu Schaaf
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Thomas Bochaton
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | | | - Gilles Rioufol
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Gérard Finet
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | | | | | - Meyer Elbaz
- Centre Hospitalier Universitaire de Rangueil
| | | | | | | | | | | | | | | | | | - Inesse Boussaha
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Michel Ovize
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon
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Van't Hof A, Giannini F, Ten Berg J, Tolsma R, Clemmensen P, Bernstein D, Coste P, Goldstein P, Zeymer U, Hamm C, Deliargyris E, Steg PG. ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention: The EUROMAX ST-segment resolution substudy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 6:404-411. [PMID: 26250825 DOI: 10.1177/2048872615598633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin or enoxaparin with or without GPIIb/IIIa inhibitors (GPIs) in primary PCI. This nested substudy was performed in centres routinely using pre-hospital GPI in order to compare the impact of randomized treatments on ST-resolution after primary PCI. METHODS Residual cumulative ST-segment deviation on the single one hour post-procedure electrocardiogram (ECG) was assessed by an independent core laboratory and was the primary endpoint. It was calculated that 762 evaluable patients were needed to show non-inferiority (85% power, alpha 2.5%) between randomized treatments. RESULTS A total of 871 participated with electrocardiographic data available in 824 patients (95%). Residual ST-segment deviation one hour after PCI was 3.8±4.9 mm versus 3.9±5.2 mm for bivalirudin and heparin+GPI, respectively ( p=0.0019 for non-inferiority). Overall, there were no differences between randomized treatments in any measures of ST-segment resolution either before or after the index procedure. CONCLUSIONS Pre-hospital treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI with regard to residual ST-segment deviation or ST-segment resolution, reflecting comparable myocardial reperfusion with the two strategies.
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Affiliation(s)
| | | | | | | | | | | | - Pierre Coste
- 6 Centre Hospitalier Universitaire Bordeaux, Université de Bordeaux, France
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Rommel KP, Baum A, Mende M, Desch S, Gutberlet M, Schuler G, Thiele H, Eitel I. Prognostic significance and relationship of worst lead residual ST segment elevation with myocardial damage assessed by cardiovascular MRI in myocardial infarction. Heart 2014; 100:1257-63. [DOI: 10.1136/heartjnl-2013-305462] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cortese B, Limbruno U, Severi S, De Matteis S, Diehl L, Pitì A. Effect of prolonged Bivalirudin infusion on ST-segment resolution following primary percutaneous coronary intervention (from the PROBI VIRI 2 study). Am J Cardiol 2011; 108:1220-4. [PMID: 21855837 DOI: 10.1016/j.amjcard.2011.06.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
Abstract
Bivalirudin is widely used as an anticoagulant during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction. However, an increase in acute stent thrombosis rates has been found in the HORIZONS-AMI trial. A prolonged infusion after PCI has been shown to be a safe and effective tool in patients undergoing urgent or elective PCI in the PROBI VIRI study. We examined the effects of prolonged drug infusion after primary PCI. From databases of 5 high-volume centers we compared a group of patients treated with a 4-hour prolonged infusion after PCI to 2 groups treated with a peri-PCI infusion and heparin plus abciximab. The primary study end point was >70% ST-segment resolution within 90 minutes after PCI; secondary end points were partial (>50%) ST-segment resolution within 90 minutes and intrahospital major and minor bleedings on the Acuity scale. The study population consisted of 264 patients undergoing primary PCI who were pretreated with aspirin and clopidogrel. The 3 study groups did not differ significantly by baseline characteristics. The primary end point was achieved in 69.8%, 48.8%, and 69.6% of patients in the prolonged bivalirudin, bivalirudin, and heparin/abciximab groups, respectively (p = 0.048 for prolonged vs standard infusion, p = 0.98 for prolonged infusion vs abciximab). Major bleedings and other secondary study end points were not significantly different among study groups. In conclusion, a strategy of prolonged bivalirudin infusion after primary PCI seems equivalent to a strategy with heparin plus abciximab, with an improvement in standard infusion in obtaining early microvascular reperfusion.
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