Key result
Intracoronary ECG ST-segment resolution over ~42% during primary PCI predicts LVEF recovery in no-reflow STEMI.
Why the study?
The no-reflow phenomenon increases mortality and morbidity in STEMI, but predicting primary PCI procedural success in these patients remains challenging.
Does the percentage change in ST-segment resolution measured by intracoronary electrocardiography predict LVEF recovery in STEMI patients who develop no-reflow phenomenon during primary PCI?
Observational (n=71)
Does the percentage change in ST-segment resolution measured by intracoronary electrocardiography predict LVEF recovery in STEMI patients who develop no-reflow phenomenon during primary PCI?
Intracoronary ECG ST-segment resolution >42% during primary PCI is a strong independent predictor of LVEF recovery in patients with anterior STEMI complicated by no-reflow.
Answers are grounded in this paper and cite their sources.
ic-ECG may predict pPCI success in NRP STEMI; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: The no-reflow phenomenon (NRP) is associated with increased mortality and morbidity in patients with ST-segment elevation myocardial infarction (STEMI). Despite the lack of a definitive treatment for NRP, predicting procedural success remains a challenge. This study aims to evaluate the potential of intracoronary electrocardiography (ic-ECG) in predicting the success of the primary percutaneous coronary intervention (pPCI) in STEMI patients who develop NRP. METHODS: Patients with acute anterior STEMI who underwent pPCI between November 2021 and May 2022 were included in this prospective study. Patients were categorized into two groups based on the thrombolysis in myocardial infarction (TIMI) flow grade, with those having a grade less than 3 defined as NRP. The NRP group was further analyzed to explore the relationship between the percentage of ST-segment resolution (STR) in ic-ECG records taken during pPCI and the recovery of left ventricular ejection fraction (LVEF). RESULTS: Seventy-one patients with acute anterior STEMI were included in the study, 26 of whom (36.6%) developed the NRP. Baseline characteristics such as peak troponin levels (6267.8±2488.4 vs. 3244.6±3183 ng/mL, P=0.013), low-density lipoprotein cholesterol (LDL-C) levels (104.5±40 vs. 138.8±29.9 mg/dL, P=0.021), and total cholesterol levels (167.5±44.5 vs. 222.7±69.2 mg/dL, P=0.024) were significantly different between patients with and without LVEF recovery in the NRP group. Importantly, the change in ic-ECG STR was significantly higher in the recovery group (65.5±17% vs. 21±22.3%, P<0.001). Multivariate regression analysis confirmed that the percentage change in ic-ECG STR was an independent predictor of LVEF recovery (P=0.035). A cut-off ic-ECG STR change greater than 42% was identified through ROC analysis as a predictor of LVEF recovery with a sensitivity of 100% and specificity of 84.6% (AUC=0.938, P<0.001). CONCLUSIONS: The percentage change in ST-segment resolution measured by ic-ECG is an independent predictor of LVEF recovery in STEMI patients who develop NRP. A greater than 42% change in ic-ECG STR during the procedure is independently associated with improved LVEF, highlighting its value in guiding clinical decision-making and improving patient outcomes.
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İbiş et al. (2025) conducted an observational in Acute anterior STEMI with no-reflow phenomenon (n=71). Intracoronary electrocardiography ST-segment resolution (ic-ECG STR) vs. Lower ic-ECG STR was evaluated on Recovery of left ventricular ejection fraction (LVEF) (AUC 0.938, p=<0.001). A greater than 42% change in intracoronary ECG ST-segment resolution during primary PCI independently predicted LVEF recovery in STEMI patients with no-reflow (AUC=0.938, P<0.001).
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