Heart Center, Department of Cardiology, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland.
Heart Center, Department of Cardiology, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland.
Int J Cardiol. 2020 Nov 15;319:40-45. doi: 10.1016/j.ijcard.2020.05.053. Epub 2020 May 26.
Useful tools for risk assessment in patients with STEMI are needed. We evaluated the prognostic impact of the evolving myocardial infarction (EMI) and the preinfarction syndrome (PIS) ECG patterns and determined their correlation with angiographic findings and treatment strategy.
This substudy of the randomized Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL) included 7860 patients with STEMI and either the EMI or the PIS ECG pattern. The primary outcome was a composite of death from cardiovascular causes, recurrent MI, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year.
The primary outcome occurred in 271 of 2618 patients (10.4%) in the EMI group vs. 322 of 5242 patients (6.1%) in the PIS group [AdjustedHR, 1.54; 95% CI, 1.30 to 1.82; p < .001]. The primary outcome occurred in the thrombectomy and PCI alone groups in 131 of 1306 (10.0%) and 140 of 1312 (10.7%) patients with EMI [HR 0.94; 95% CI, 0.74-1.19] and 162 of 2633 (6.2%) and 160 of 2609 (6.1%) patients with PIS [HR 1.00; 95% CI, 0.81-1.25], respectively (p = 0.679).
Patients with the EMI ECG pattern proved to have an increased rate of the primary outcome within one year compared to the PIS pattern. Routine manual thrombectomy did not reduce the risk of primary outcome within the different dynamic ECG patterns. The PIS/EMI dynamic ECG classification could help to triage patients in case of simultaneous STEMI patients with immediate need for pPCI.
需要有用的工具来评估 STEMI 患者的风险。我们评估了不断发展的心肌梗死（EMI）和前梗死综合征（PIS）心电图模式的预后影响，并确定了它们与血管造影结果和治疗策略的相关性。
这项随机试验的子研究，即 STEMI 患者常规抽吸血栓切除术与单独 PCI 的比较（TOTAL）纳入了 7860 例 STEMI 患者，他们的心电图模式为 EMI 或 PIS。主要结局是一年内心血管原因死亡、再发心肌梗死、心源性休克或纽约心脏协会（NYHA）心功能 IV 级心力衰竭的复合结局。
在 EMI 组的 2618 例患者中，主要结局发生在 271 例（10.4%）患者中，而在 PIS 组的 5242 例患者中，主要结局发生在 322 例（6.1%）患者中[调整后的 HR，1.54；95%CI，1.30 至 1.82；p<0.001]。在接受血栓切除术和单独 PCI 的患者中，EMI 组的 1306 例患者中有 131 例（10.0%）和 1312 例患者中有 140 例（10.7%）发生主要结局[HR 0.94；95%CI，0.74-1.19]，而 PIS 组的 2633 例患者中有 162 例（6.2%）和 2609 例患者中有 160 例（6.1%）发生主要结局[HR 1.00；95%CI，0.81-1.25]（p=0.679）。
与 PIS 模式相比，EMI 心电图模式的患者在一年内主要结局的发生率更高。常规手动血栓切除术并不能降低不同动态心电图模式下主要结局的风险。PIS/EMI 动态心电图分类可帮助分诊同时发生且需要立即行 pPCI 的 STEMI 患者。
