Department of Cardiology, Medical University in Bialystok, Bialystok, Poland.
Can J Cardiol. 2011 Sep-Oct;27(5):573-80. doi: 10.1016/j.cjca.2011.01.010. Epub 2011 Jun 11.
Limited data exist in regard to the correlation between ST-segment resolution (STR) in patients treated with primary percutaneous coronary intervention (pPCI) and very late mortality. The aim of the study was to determine the correlation between STR and 6-year mortality in patients successfully treated with pPCI.
We prospectively studied a group of 303 patients who had sustained an acute myocardial infarction with ST-segment elevation and subsequently exhibited TIMI 3 flow after pPCI. The patients were analyzed in 2 groups according to STR.
There were 222 patients (73.3%) with STR and 81 patients (26.7%) without it. The mean "pain-to-balloon" time was 4.3 ± 2.1 hours in the former group vs 4.9 ± 2.8 hours in the latter (P = 0.016). In total, 64 people (21%) died during the 6-year follow-up period: 37 (17%) showed STR and 28 (35%) did not (P < 0.001). In multivariate analysis, STR, ejection fraction, and maximum creatine kinase and creatine kinase-MB levels were all associated with death. Anterior myocardial infarction, "pain-to-balloon" time, and ejection fraction were all further associated with lack of STR.
Lack of early STR is associated with significantly higher mortality rates after successful pPCI during a 6-year follow-up period. Absence of an early STR appears to identify patients who are less likely to benefit from the early restoration of infarct-affected artery, possibly due to microvascular damage. STR therefore appears to be a powerful prognostic marker for the occurrence of an acute myocardial infarction 6 years later.
关于接受经皮冠状动脉介入治疗（pPCI）的患者 ST 段缓解（STR）与极晚期死亡率之间的相关性，目前仅有有限的数据。本研究的目的是确定 STR 与成功接受 pPCI 治疗的患者 6 年死亡率之间的相关性。
我们前瞻性研究了一组 303 名患有急性 ST 段抬高型心肌梗死且随后接受 pPCI 后出现 TIMI 3 级血流的患者。根据 STR 将患者分为两组进行分析。
222 例患者（73.3%）出现 STR，81 例患者（26.7%）未出现 STR。前者的平均“胸痛至球囊”时间为 4.3 ± 2.1 小时，后者为 4.9 ± 2.8 小时（P = 0.016）。在 6 年的随访期间，共有 64 人（21%）死亡：37 人（17%）出现 STR，28 人（35%）未出现 STR（P < 0.001）。多变量分析显示，STR、射血分数以及肌酸激酶和肌酸激酶同工酶的最大水平均与死亡相关。前壁心肌梗死、“胸痛至球囊”时间和射血分数与缺乏 STR 进一步相关。
在接受成功 pPCI 后 6 年的随访期间，缺乏早期 STR 与死亡率显著升高相关。早期 STR 缺失似乎表明患者不太可能从梗死相关动脉的早期恢复中获益，这可能是由于微血管损伤所致。因此，STR 似乎是 6 年后发生急性心肌梗死的一个强大预后标志物。
