What is the best ST-segment recovery parameter to predict clinical outcome and myocardial infarct size? Amplitude, speed, and completeness of ST-segment recovery after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
作者信息
Kuijt Wichert J, Green Cindy L, Verouden Niels J W, Haeck Joost D E, Tzivoni Dan, Koch Karel T, Stone Gregg W, Lansky Alexandra J, Broderick Samuel, Tijssen Jan G P, de Winter Robbert J, Roe Matthew T, Krucoff Mitchell W
机构信息
Duke Clinical Research Institute, Durham, NC, USA; Academic Medical Center, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
Duke Clinical Research Institute, Durham, NC, USA.
出版信息
J Electrocardiol. 2017 Nov-Dec;50(6):952-959. doi: 10.1016/j.jelectrocard.2017.04.009. Epub 2017 Apr 22.
AIMS
ST-segment recovery (STR) is a strong mechanistic correlate of infarct size (IS) and outcome in ST-segment elevation myocardial infarction (STEMI). Characterizing measures of speed, amplitude, and completeness of STR may extend the use of this noninvasive biomarker.
METHODS AND RESULTS
Core laboratory continuous 24-h 12-lead Holter ECG monitoring, IS by single-photon emission computed tomography (SPECT), and 30-day mortality of 2 clinical trials of primary percutaneous coronary intervention in STEMI were combined. Multiple ST measures (STR at last contrast injection (LC) measured from peak value; 30, 60, 90, 120, and 240min, residual deviation; time to steady ST recovery; and the 3-h area under the time trend curve [ST-AUC] from LC) were univariably correlated with IS and predictive of mortality. After multivariable adjustment for ST-parameters and GRACE risk factors, STR at 240min remained an additive predictor of mortality. Early STR, residual deviation, and ST-AUC remained associated with IS.
CONCLUSIONS
Multiple parameters that quantify the speed, amplitude, and completeness of STR predict mortality and correlate with IS.
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