Predictive Value of ST Resolution Analysis Performed Immediately Versus at Ninety Minutes After Primary Percutaneous Coronary Intervention
ST segment resolution (STR) predicts epicardial and microvascular reperfusion after primary percutaneous coronary intervention (PPCI) or thrombolysis for ST-elevation myocardial infarction. Immediate restoration of epicardial coronary flow, with improved microvascular perfusion, is much more likely...
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| Veröffentlicht in: | The American journal of cardiology 2010-02, Vol.105 (4), p.467-474 |
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| creator | Kumar, Saurabh, BSc, MBBS Sivagangabalan, Gopal, MBBS Hsieh, Calvin, MBBS Ryding, Alisdair D.S., MBBS, PhD Narayan, Arun, RN Chan, Hera, MBBS Burgess, David C., MBBS, MPH, PhD Ong, Andrew T.L., MBBS, PhD Sadick, Norman, MBBS, PhD Kovoor, Pramesh, MBBS, PhD |
| description | ST segment resolution (STR) predicts epicardial and microvascular reperfusion after primary percutaneous coronary intervention (PPCI) or thrombolysis for ST-elevation myocardial infarction. Immediate restoration of epicardial coronary flow, with improved microvascular perfusion, is much more likely with PPCI. However, the predictive value of immediate STR compared to 90 minutes after PPCI remains unknown. In 622 consecutive patients with ST-elevation myocardial infarction (mean age 59 ± 13 years), 217 had complete STR immediately after PPCI (group A), 188 had complete STR only at 90 minutes (group B), and 217 had incomplete STR at either point (group C). The primary end point was mortality and adverse cardiovascular events ([MACE] death, nonfatal repeat myocardial infarction, and heart failure). Group A had a greater left ventricular ejection fraction (53%, 47%, and 46%, p |
| doi_str_mv | 10.1016/j.amjcard.2009.10.017 |
| format | Article |
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Immediate restoration of epicardial coronary flow, with improved microvascular perfusion, is much more likely with PPCI. However, the predictive value of immediate STR compared to 90 minutes after PPCI remains unknown. In 622 consecutive patients with ST-elevation myocardial infarction (mean age 59 ± 13 years), 217 had complete STR immediately after PPCI (group A), 188 had complete STR only at 90 minutes (group B), and 217 had incomplete STR at either point (group C). The primary end point was mortality and adverse cardiovascular events ([MACE] death, nonfatal repeat myocardial infarction, and heart failure). Group A had a greater left ventricular ejection fraction (53%, 47%, and 46%, p <0.001) and lower all-cause mortality (1.8%, 3.2%, and 6%, p = 0.07), lower heart failure (1.8%, 4.3%, and 7.8%, p <0.001), and MACE (5.1%, 9.6%, and 16.1%, p = 0.001) at 30 days compared to groups B and C, respectively. The rate of MACE at 1 year was 7.6%, 17.1%, and 20.2% in groups A, B, and C, respectively (p <0.001). Immediate STR independently predicted MACE (adjusted hazard ratio 0.36, 95% confidence interval 0.21 to 0.61, p = 0.001, group A vs C), and STR at 90 minutes did not. In conclusion, STR analysis performed immediately after PPCI provided superior differentiation for adverse cardiovascular events compared to STR at 90 minutes. Immediate STR should be the contemporary goal of reperfusion with PPCI.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2009.10.017</identifier><identifier>PMID: 20152240</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Angioplasty ; Angioplasty, Balloon, Coronary ; Anticoagulants - therapeutic use ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Confidence Intervals ; Coronary Thrombosis - drug therapy ; Coronary Thrombosis - physiopathology ; Diseases of the cardiovascular system ; Electrocardiography ; Female ; Heart attacks ; Heart Conduction System - drug effects ; Heart Conduction System - physiopathology ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - physiopathology ; Humans ; Male ; Medical sciences ; Middle Aged ; Mortality ; Myocardial Infarction - diagnosis ; Myocardial Infarction - drug therapy ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Odds Ratio ; Patients ; Predictive Value of Tests ; Prognosis ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stents ; Survival Analysis ; Thrombolytic Therapy - methods ; Thrombosis ; Time Factors ; Vasodilator Agents - therapeutic use</subject><ispartof>The American journal of cardiology, 2010-02, Vol.105 (4), p.467-474</ispartof><rights>2010</rights><rights>2015 INIST-CNRS</rights><rights>Copyright 2010. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Sequoia S.A. Feb 15, 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c542t-4bcc8719627b977e3957fb3eb551464aa244b4e6caba65290f9e279ef177ce263</citedby><cites>FETCH-LOGICAL-c542t-4bcc8719627b977e3957fb3eb551464aa244b4e6caba65290f9e279ef177ce263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjcard.2009.10.017$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22472803$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20152240$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kumar, Saurabh, BSc, MBBS</creatorcontrib><creatorcontrib>Sivagangabalan, Gopal, MBBS</creatorcontrib><creatorcontrib>Hsieh, Calvin, MBBS</creatorcontrib><creatorcontrib>Ryding, Alisdair D.S., MBBS, PhD</creatorcontrib><creatorcontrib>Narayan, Arun, RN</creatorcontrib><creatorcontrib>Chan, Hera, MBBS</creatorcontrib><creatorcontrib>Burgess, David C., MBBS, MPH, PhD</creatorcontrib><creatorcontrib>Ong, Andrew T.L., MBBS, PhD</creatorcontrib><creatorcontrib>Sadick, Norman, MBBS, PhD</creatorcontrib><creatorcontrib>Kovoor, Pramesh, MBBS, PhD</creatorcontrib><title>Predictive Value of ST Resolution Analysis Performed Immediately Versus at Ninety Minutes After Primary Percutaneous Coronary Intervention</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>ST segment resolution (STR) predicts epicardial and microvascular reperfusion after primary percutaneous coronary intervention (PPCI) or thrombolysis for ST-elevation myocardial infarction. Immediate restoration of epicardial coronary flow, with improved microvascular perfusion, is much more likely with PPCI. However, the predictive value of immediate STR compared to 90 minutes after PPCI remains unknown. In 622 consecutive patients with ST-elevation myocardial infarction (mean age 59 ± 13 years), 217 had complete STR immediately after PPCI (group A), 188 had complete STR only at 90 minutes (group B), and 217 had incomplete STR at either point (group C). The primary end point was mortality and adverse cardiovascular events ([MACE] death, nonfatal repeat myocardial infarction, and heart failure). Group A had a greater left ventricular ejection fraction (53%, 47%, and 46%, p <0.001) and lower all-cause mortality (1.8%, 3.2%, and 6%, p = 0.07), lower heart failure (1.8%, 4.3%, and 7.8%, p <0.001), and MACE (5.1%, 9.6%, and 16.1%, p = 0.001) at 30 days compared to groups B and C, respectively. The rate of MACE at 1 year was 7.6%, 17.1%, and 20.2% in groups A, B, and C, respectively (p <0.001). Immediate STR independently predicted MACE (adjusted hazard ratio 0.36, 95% confidence interval 0.21 to 0.61, p = 0.001, group A vs C), and STR at 90 minutes did not. In conclusion, STR analysis performed immediately after PPCI provided superior differentiation for adverse cardiovascular events compared to STR at 90 minutes. Immediate STR should be the contemporary goal of reperfusion with PPCI.</description><subject>Aged</subject><subject>Angioplasty</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Anticoagulants - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Confidence Intervals</subject><subject>Coronary Thrombosis - drug therapy</subject><subject>Coronary Thrombosis - physiopathology</subject><subject>Diseases of the cardiovascular system</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart Conduction System - drug effects</subject><subject>Heart Conduction System - physiopathology</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Odds Ratio</subject><subject>Patients</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Stents</subject><subject>Survival Analysis</subject><subject>Thrombolytic Therapy - methods</subject><subject>Thrombosis</subject><subject>Time Factors</subject><subject>Vasodilator Agents - therapeutic use</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkltrFDEUxwdR7Lb6EZQgiE-z5jKZbF6UZfGyUHWxta8hkz0DGWeTNskszFfopzbDrBX64ksOOfzO9X-K4hXBS4JJ_b5b6kNndNgvKcYy-5aYiCfFgqyELIkk7GmxwBjTUpJKnhXnMXb5SwivnxdnFBNOaYUXxf0uwN6aZI-AbnQ_APIturpGPyH6fkjWO7R2uh-jjWgHofXhAHu0PeTX6gT9iG4gxCEindB36yCN6Jt1Q4KI1m2CgHbBHnQYp2AzJO3AZ3jjg3eTd-sycwQ3FXpRPGt1H-HlyV4Uvz5_ut58LS9_fNlu1pel4RVNZdUYsxJE1lQ0Ughgkou2YdBwTqq60ppWVVNBbXSja04lbiVQIaElQhigNbso3s15b4O_GyAmdbDRQN_PzSnBmFjVuJ7IN4_Izg8hryMqyjATknOZIT5DJvgYA7Tqdh5ZEawmqVSnTlKpSarJnaXKca9PyYcmb_Mh6q82GXh7AnQ0um-DdsbGfxytBF1hlrmPMwd5aUcLQUVjwZmsUACT1N7b_7by4VEG01tnc9HfMEJ8GJqoSBVWV9NdTWeFJaY8t8H-AEcCytc</recordid><startdate>20100215</startdate><enddate>20100215</enddate><creator>Kumar, Saurabh, BSc, MBBS</creator><creator>Sivagangabalan, Gopal, MBBS</creator><creator>Hsieh, Calvin, MBBS</creator><creator>Ryding, Alisdair D.S., MBBS, PhD</creator><creator>Narayan, Arun, RN</creator><creator>Chan, Hera, MBBS</creator><creator>Burgess, David C., MBBS, MPH, PhD</creator><creator>Ong, Andrew T.L., MBBS, PhD</creator><creator>Sadick, Norman, MBBS, PhD</creator><creator>Kovoor, Pramesh, MBBS, PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20100215</creationdate><title>Predictive Value of ST Resolution Analysis Performed Immediately Versus at Ninety Minutes After Primary Percutaneous Coronary Intervention</title><author>Kumar, Saurabh, BSc, MBBS ; Sivagangabalan, Gopal, MBBS ; Hsieh, Calvin, MBBS ; Ryding, Alisdair D.S., MBBS, PhD ; Narayan, Arun, RN ; Chan, Hera, MBBS ; Burgess, David C., MBBS, MPH, PhD ; Ong, Andrew T.L., MBBS, PhD ; Sadick, Norman, MBBS, PhD ; Kovoor, Pramesh, MBBS, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c542t-4bcc8719627b977e3957fb3eb551464aa244b4e6caba65290f9e279ef177ce263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Angioplasty</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Anticoagulants - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Confidence Intervals</topic><topic>Coronary Thrombosis - drug therapy</topic><topic>Coronary Thrombosis - physiopathology</topic><topic>Diseases of the cardiovascular system</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Heart Conduction System - drug effects</topic><topic>Heart Conduction System - physiopathology</topic><topic>Heart failure</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Odds Ratio</topic><topic>Patients</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Radiotherapy. 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Immediate restoration of epicardial coronary flow, with improved microvascular perfusion, is much more likely with PPCI. However, the predictive value of immediate STR compared to 90 minutes after PPCI remains unknown. In 622 consecutive patients with ST-elevation myocardial infarction (mean age 59 ± 13 years), 217 had complete STR immediately after PPCI (group A), 188 had complete STR only at 90 minutes (group B), and 217 had incomplete STR at either point (group C). The primary end point was mortality and adverse cardiovascular events ([MACE] death, nonfatal repeat myocardial infarction, and heart failure). Group A had a greater left ventricular ejection fraction (53%, 47%, and 46%, p <0.001) and lower all-cause mortality (1.8%, 3.2%, and 6%, p = 0.07), lower heart failure (1.8%, 4.3%, and 7.8%, p <0.001), and MACE (5.1%, 9.6%, and 16.1%, p = 0.001) at 30 days compared to groups B and C, respectively. The rate of MACE at 1 year was 7.6%, 17.1%, and 20.2% in groups A, B, and C, respectively (p <0.001). Immediate STR independently predicted MACE (adjusted hazard ratio 0.36, 95% confidence interval 0.21 to 0.61, p = 0.001, group A vs C), and STR at 90 minutes did not. In conclusion, STR analysis performed immediately after PPCI provided superior differentiation for adverse cardiovascular events compared to STR at 90 minutes. Immediate STR should be the contemporary goal of reperfusion with PPCI.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20152240</pmid><doi>10.1016/j.amjcard.2009.10.017</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Angioplasty Angioplasty, Balloon, Coronary Anticoagulants - therapeutic use Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular Confidence Intervals Coronary Thrombosis - drug therapy Coronary Thrombosis - physiopathology Diseases of the cardiovascular system Electrocardiography Female Heart attacks Heart Conduction System - drug effects Heart Conduction System - physiopathology Heart failure Heart Failure - drug therapy Heart Failure - physiopathology Humans Male Medical sciences Middle Aged Mortality Myocardial Infarction - diagnosis Myocardial Infarction - drug therapy Myocardial Infarction - mortality Myocardial Infarction - physiopathology Odds Ratio Patients Predictive Value of Tests Prognosis Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Retrospective Studies Risk Assessment Risk Factors Severity of Illness Index Stents Survival Analysis Thrombolytic Therapy - methods Thrombosis Time Factors Vasodilator Agents - therapeutic use |
| title | Predictive Value of ST Resolution Analysis Performed Immediately Versus at Ninety Minutes After Primary Percutaneous Coronary Intervention |
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