Spitaleri Giosafat, Brugaletta Salvatore, Scalone Giancarla, Moscarella Elisabetta, Ortega-Paz Luis, Pernigotti Alberto, Gomez-Lara Josep, Cequier Angel, Iñiguez Andrés, Serra Antonio, Jiménez-Quevedo Pilar, Mainar Vicente, Campo Gianluca, Tespili Maurizio, den Heijer Peter, Bethencourt Armando, Vazquez Nicolás, Valgimigli Marco, Serruys Patrick W, Sabaté Manel
University Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
University Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Am J Cardiol. 2018 May 1;121(9):1039-1045. doi: 10.1016/j.amjcard.2018.01.015. Epub 2018 Feb 7.
In patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), lack of ST-segment resolution (STR) is associated with poor prognosis at short- and long-term follow-up. The aim of this study was to evaluate the role of STR on very long-term outcomes in patients with STEMI treated with pPCI included in the EXAMINATION (Evaluation of the Xience-V Stent in Acute Myocardial Infarction) trial. Patients were stratified according to the presence of STR < 50% and STR < 70% at the 30-minute post-pPCI electrocardiogram. Primary end point was the patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction, or any revascularization at 5-year follow-up. Both baseline and post-PCI 30-minute electrocardiograms were available for STR assessment in 1,351 patients. Of these patients, 228 (16.9%) and 500 (37.0%) exhibited STR < 50% and STR < 70%, respectively. At 5-year follow-up, the POCE was observed more frequently in patients with STR < 50% (hazard ratio [HR] 1.556; 95% confidence interval [CI] 1.194 to 2.027; p <0.001) and in patients with STR < 70% (HR 1.460, 95% CI 1.169 to 1.824, p <0.001) compared with patients with STR > 50% and STR ≥ 70%, respectively. In both cases, this difference was mainly driven by a significant increase in the rate of all-cause death and any revascularization. After multivariable adjustment, STR < 70%, but not STR < 50%, resulted as a 5-year independent predictor of POCE (adjusted HR 1.338, 95% CI 1.008 to 1.778, p = 0.044). In conclusion, in patients with STEMI, the evaluation of 70% STR after pPCI provides independent prognostic information at 5-year follow-up and it can be used to identify patients at high risk of very long-term cardiovascular events.
在接受直接经皮冠状动脉介入治疗（pPCI）的ST段抬高型心肌梗死（STEMI）患者中，ST段未完全回落（STR）与短期和长期随访的不良预后相关。本研究的目的是评估STR在EXAMINATION（急性心肌梗死中Xience-V支架评估）试验中接受pPCI治疗的STEMI患者的极长期预后中的作用。根据pPCI术后30分钟心电图中STR<50%和STR<70%的情况对患者进行分层。主要终点是5年随访时的全因死亡、任何心肌梗死或任何血运重建的以患者为导向的复合终点（POCE）。1351例患者的基线和PCI术后30分钟心电图均可用于STR评估。在这些患者中，分别有228例（16.9%）和500例（37.0%）表现出STR<50%和STR<70%。在5年随访时，与STR>50%和STR≥70%的患者相比，STR<50%（风险比[HR]1.556；95%置信区间[CI]1.194至2.027；p<0.001）和STR<70%（HR 1.460，95%CI 1.169至1.824，p<0.001）的患者中POCE更为常见。在这两种情况下，这种差异主要是由全因死亡率和任何血运重建率的显著增加所驱动。经过多变量调整后，STR<70%，而不是STR<50%，成为POCE的5年独立预测因素（调整后HR为1.338，95%CI为1.008至1.778，p=0.044）。总之，在STEMI患者中，pPCI术后70%STR的评估在5年随访时提供独立的预后信息，并且可用于识别极长期心血管事件高危患者。
