ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-segment elevation myocardial infarction (STEMI) with patent infarct-related artery (n=155). Intervention: ST-segment re-elevation (reSTE) following primary PCI vs. ST-segment resolution following PCI (T3Res). Primary outcome: Change in left ventricular ejection fraction (LVEF) at 6 months (p=< 0.05).

Krzysztof Krawczyk; Konrad Stępień; Karol Nowak; Jadwiga Nessler; J Zalewski

doi:10.5114/aic.2019.90215

January 1, 2019Advances in Interventional CardiologyOpen Access

ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

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Key result

ST-segment re-elevation following primary PCI in a patent infarct-related artery was associated with a lack of improvement in left ventricular ejection fraction (0.2% vs 3.9% with resolution) at 6 months.

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Why the study?

Spontaneous recanalization of the IRA in STEMI before primary PCI improves outcomes, but the impact of ST-segment re-elevation following PCI in patent IRA on LV function recovery and remodeling was unknown.

Does ST-segment re-elevation following primary PCI in a patent infarct-related artery affect left ventricular function recovery and remodeling in STEMI patients?

Study Design

Type

Observational (n=155)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does ST-segment re-elevation following primary PCI in a patent infarct-related artery affect left ventricular function recovery and remodeling in STEMI patients?

P

Population

155 STEMI patients with a patent infarct-related artery (IRA) at baseline (TIMI 2 or 3 flow on initial contrast injection), chest pain onset within 12 h, and ST-segment elevation ≥ 1 mm in ≥ 2 contiguous leads or ≥ 2 mm in ≥ 2 contiguous precordial leads. Exclusions included cardiogenic shock, previous CABG, malignancy, VTE, liver injury, serum creatinine > 177 µmol/l, and current oral anticoagulation.

I

Intervention

Primary percutaneous coronary intervention (PCI) resulting in ST-segment re-elevation (reSTE) of ≥ 1 mm following PCI (T23reSTE group, n=31)

C

Comparator

Patients with patent IRA who had ST-segment resolution following PCI (T3Res, n=85; T2Res, n=19) or did not require PCI (T3noPCI, n=20)

O

Outcome

Left ventricular (LV) function recovery and remodeling, measured by LV ejection fraction (LVEF), wall motion score index (IRA-WMSI), LV end-diastolic volume index (LVEDVI), and LV end-systolic volume index (LVESVI) via echocardiography at 2 days and 6 months following PCIsurrogate

Main Result

Absolute Event Rate: 0.2% vs 3.9%

p-value: p=< 0.05

ST-segment re-elevation following primary PCI in a patent infarct-related artery is associated with a lack of improvement in left ventricular contractility and subsequent adverse remodeling.

Limitations

The sample size and the number of clinical adverse events are not large enough to draw clinical conclusions.
Left ventricular remodeling was assessed by echocardiography, although cardiac magnetic resonance is a more accurate and objective method.
Subsequent ECGs, including 60-90 min after PCI, were not prospectively recorded.
Platelet reactivity, fibrin clot properties and intracoronary thrombi were not analyzed.

Implication

May flag STEMI patients for poor LVEF recovery post-PCI; leaves open need for validation and targeted trials.

Abstract

INTRODUCTION: Spontaneous recanalization of the infarct-related artery (IRA) in ST-segment elevation myocardial infarction (STEMI) before primary angioplasty (PCI) improves clinical outcomes. AIM: To investigate the impact of ST-segment re-elevation (reSTE) following PCI in patent IRA on left ventricular (LV) function recovery and remodeling. MATERIAL AND METHODS: ) were measured by echocardiography 2 days and 6 months following PCI. RESULTS: < 0.001 for all). CONCLUSIONS: ReSTE following PCI in a patent IRA is associated with a lack of improvement of LV contractility and subsequent LV remodeling.

Discussion

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Cite This Study

Krawczyk et al. (2019) conducted an observational in ST-segment elevation myocardial infarction (STEMI) with patent infarct-related artery (n=155). ST-segment re-elevation (reSTE) following primary PCI vs. ST-segment resolution following PCI (T3Res) was evaluated on Change in left ventricular ejection fraction (LVEF) at 6 months (p=< 0.05). ST-segment re-elevation following primary PCI in a patent infarct-related artery was associated with a lack of improvement in left ventricular ejection fraction (0.2% vs 3.9% with resolution) at 6 months.

synapsesocial.com/papers/6a1aec2b37bfaf0f5945d4c6 https://doi.org/10.5114/aic.2019.90215

Topics

STEMI management

Percutaneous coronary intervention

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ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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Topics

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