Key result
Worst lead residual ST segment elevation ≥2 mm 90 minutes post-PCI was significantly associated with an increased risk of MACE at 12 months (HR 1.93; 95% CI 1.11-3.37; p=0.02).
Cohort (n=763)
Yes
Hazard Ratio: 1.93 (95% CI 1.11–3.37)
p-value: p=0.02
Residual worst lead ST segment elevation ≥2 mm 90 minutes post-PCI in STEMI patients is significantly associated with larger infarct size, greater microvascular obstruction, and higher 12-month MACE risk.
Residual ST elevation ≥2 mm post-PCI signals higher MACE risk in STEMI; hypothesis-generating for risk stratification, should not yet change practice.
OBJECTIVE: To investigate the relation of residual worst lead ST segment elevation (WL-STE) after ST segment myocardial infarction (STEMI) with infarct size and microvascular injury assessed by cardiovascular magnetic resonance (CMR) imaging. BACKGROUND: WL-STE in patients with acute reperfused STEMI has been shown to identify high risk patients for major adverse cardiovascular events (MACE). However, the relation of WL-STE with myocardial damage is unknown. METHODS: In this multicentre study we analysed ECG data 90 min after primary percutaneous coronary intervention (PCI) in 763 STEMI patients. WL-STE was defined as the absolute magnitude of STE in the most affected lead on the post-PCI ECG. Patients were categorised into three groups (<1 mm, 1-2 mm, and ≥2 mm). CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardised protocol. The primary clinical endpoint was MACE defined as death, reinfarction, and new congestive heart failure within 12 months after infarction. RESULTS: WL-STE <1 mm, 1-2 mm, and ≥2 mm was present in 155 (20%), 328 (43%), and 280 (37%) patients, respectively. Myocardial damage determined by CMR demonstrated a graded relationship of infarct size (median (IQR) 13.3 (6.2-20.3)%LV vs 13.7 (7.6-21.3)%LV vs 22.5 (15.6-31.2)%LV, p<0.001), the myocardial salvage index (60.8 (37.0-84.5) vs 55.0 (36.6-73.9) vs 42.7 (26.2-58.2), p<0.001), and microvascular obstruction (0.0 (0.0-0.9)%LV vs 0.0 (0-1.0)%LV vs 1.2 (0.0-3.6)%LV, p<0.001) across the three groups. WL-STE ≥2 mm was strongly associated with MACE 12 month after infarction (HR 1.93, 95% CI 1.11 to 3.37; p=0.02). CONCLUSIONS: This largest CMR study to date correlating post-PCI WL-STE with markers of myocardial damage demonstrates that WL-STE is significantly associated with infarct size, myocardial salvage, microvascular obstruction, and MACE in a high risk STEMI population. TRIAL REGISTRATION NUMBER: NCT00712101.
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Rommel et al. (2014) conducted a cohort in ST segment myocardial infarction (STEMI) (n=763). Worst lead residual ST segment elevation (WL-STE) ≥2 mm vs. WL-STE <1 mm and 1-2 mm was evaluated on Major adverse cardiovascular events (MACE) defined as death, reinfarction, and new congestive heart failure within 12 months (HR 1.93, 95% CI 1.11 to 3.37, p=0.02). Worst lead residual ST segment elevation ≥2 mm 90 minutes post-PCI was significantly associated with an increased risk of MACE at 12 months (HR 1.93; 95% CI 1.11-3.37; p=0.02).
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