Key result
Conservative treatment in STEMI patients with negative T waves reduced infarct size by Selvester score (1.48; 95% CI 0.694-2.27), whereas primary PCI showed no significant change (-0.07).
Why the study?
A negative T wave on admission in STEMI can indicate prolonged ischemia or spontaneous reperfusion, making urgent PCI questionable.
Does primary PCI strategy reduce infarct size in STEMI patients with negative T waves compared to conservative treatment?
Observational (n=116)
Does primary PCI strategy reduce infarct size in STEMI patients with negative T waves compared to conservative treatment?
In STEMI patients presenting with negative T waves, conservative treatment was associated with a reduction in infarct size estimated by Selvester score compared to primary PCI, suggesting it might be a viable option for this specific subset.
Conservative treatment was associated with reduced infarct size in this subset; leaves open whether primary PCI confers benefit in STEMI with negative T waves.
BACKGROUND: According to current guidelines, the main indications for PCI in patients with STEMI are ST-segment deviations and defined time from the onset of symptoms. Negative T wave at admission can be a sign of prolonged ischemia or spontaneous reperfusion. In both situations, the urgent intervention is questionable. We evaluated the infarct size and in-hospital mortality in STEMI patients with negative T wave in cases of primary PCI strategy compared with conservative treatment. METHODS: A retrospective analysis of 116 STEMI patients with negative T wave at the presenting ECG was performed. Sixty-eight patients (59%) underwent primary PCI strategy (PCI group), and 48 (41%) were treated conservatively (non-PCI group). The infarct size estimated by using the Selvester score, and in-hospital mortality were evaluated. RESULTS: The difference between Selvester score values at admission and at discharge in the non-PCI group was statistically significant (1.48; 95% CI 0.694-2.27), while no significant difference was observed in the PCI group (-0.07; 95% CI -0.546-0.686). The in-hospital mortality was higher in the non-PCI group; however, the numbers were relatively small: PCI 2 (2.9%) and non-PCI 5 (10.4%). CONCLUSION: In this study, we showed a reduction in the infarct size estimated by Selvester score in STEMI patients with negative T wave who were treated conservatively, while there was no significant change in the infarct size after primary PCI strategy. The higher mortality in patients treated conservatively could be attributed to higher age and comorbidities in the non-PCI group. It seems that conservative treatment strategy might be an option in STEMI patients with negative T wave.
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Kalinauskienė et al. (2019) conducted an observational in STEMI with negative T wave (n=116). Primary PCI strategy vs. Conservative treatment was evaluated on Difference between Selvester score values at admission and at discharge. Conservative treatment in STEMI patients with negative T waves reduced infarct size by Selvester score (1.48; 95% CI 0.694-2.27), whereas primary PCI showed no significant change (-0.07).
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