Key result
Continuous ST-monitoring classification during STEMI primary PCI identifies 3 groups with distinct peak troponin-T levels.
Why the study?
In STEMI patients scheduled for primary PCI, acute risk-assessment may be valuable for tailoring adjunctive therapy at the time of coronary intervention.
Does continuous ST-monitoring classification provide prognostic information in STEMI patients undergoing primary PCI?
Observational (n=92)
Does continuous ST-monitoring classification provide prognostic information in STEMI patients undergoing primary PCI?
Continuous ST-monitoring in the pre- and per-interventional phase can stratify STEMI patients undergoing primary PCI into distinct risk profiles that correlate with infarct size and left ventricular function.
Continuous ST-monitoring classification identifies high-risk STEMI patients at primary PCI; extends ECG prognostication into the periprocedural phase.
AIMS: In patients with ST-elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively. METHODS AND RESULTS: In 92 STEMI patients, continuous ST-monitoring was initiated in the pre-hospital phase and continued during and 90 min following PCI. Patients were divided into three groups: (A) patients achieving spontaneous ST-resolution before PCI; (B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and (C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A (n=22), B (n=43), and C (n=27) differed in peak level of troponin-T (1.4, 4.7, and 7.2 microg/L, P<0.001), creatinine kinase MB isoenzyme (35, 150, and 325 microg/L, P<0.001), and N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) (183, 175, and 269 pmol/L, P=0.084) during admission, and left ventricular ejection fraction evaluated within 2 h of PCI (0.53, 0.48, and 0.45, P=0.047) and after 3 months (0.58, 0.54, and 0.45, P<0.001). Groups B and C also differed in time from first balloon inflation to > or =70% resolution of ST-elevation (14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters. CONCLUSION: STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.
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Terkelsen et al. (2005) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=92). Continuous ST-monitoring classification vs. Traditional 90 min ST-resolution analysis was evaluated on Peak level of troponin-T (p=<0.001). Continuous ST-monitoring classification in STEMI patients undergoing primary PCI identified three groups with significantly different peak troponin-T levels (1.4, 4.7, and 7.2 microg/L, P<0.001).
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