Korean Circ J.  2011 Jul;41(7):372-378. 10.4070/kcj.2011.41.7.372.

Combined Assessments of Biochemical Markers and ST-Segment Resolution Provide Additional Prognostic Information for Patients With ST-Segment Elevation Myocardial Infarction

• Woo JS
• Cho JM
• Kim SJ
• Kim MK
• Kim CJ

• KMID: 2225100
• DOI: http://doi.org/10.4070/kcj.2011.41.7.372

Abstract

BACKGROUND AND OBJECTIVES
The prognostic value of biochemical markers and the resolution of ST-segment elevation on electrocardiogram are well established. However, how a combination of these two tools affects the evaluation of risk stratification has not yet been evaluated.
SUBJECTS AND METHODS
Between January 2006 and June 2008, 178 consecutive patients treated with primary percutaneous coronary interventions after ST-segment elevation myocardial infarctions (STEMI) were analyzed at two coronary care units. Patients were divided into the following three groups according to ST-segment resolution: complete (> or =70% depression of the elevated ST-segment, n=63), partial (30% to 70%, n=90), and incomplete (<30%, n=25). Demographic data, including history, electrocardiography, biochemical markers, initial ejection fraction, and angiographic findings were also evaluated.
RESULTS
There were 7 deaths, 3 repeated myocardial infarctions, and 17 readmissions for worsening heart failure during six months of follow-up. In a multivariate analysis to predict clinical outcomes, ejection fraction {hazard ratio (HR): 0.83 (0.76-0.91), p<0.01}, high-sensitivity C-reactive protein {HR: 1.15 (1.05-1.26), p<0.05}, and the degree of ST-segment resolution {HR: 0.96 (0.93-0.09), p<0.05} were independently associated with clinical outcomes. According to the Cox-proportional hazards model, the addition of ST-segment resolution markedly improved the prognostic utility of the model containing biochemical markers and ejection fraction.
CONCLUSION
Assessment of biomarkers upon admission and ST-segment resolution are strong predictors of clinical outcomes. The combination of these data provides additive information about prognosis at an early point in the disease progression and further improves risk stratification for STEMI.

Keyword

Myocardial infarction; Prognosis; C-reactive protein; N-terminal pro-B-type natriuretic peptide; Electrocardiogram

MeSH Terms

Biomarkers
C-Reactive Protein
Coronary Care Units
Depression
Disease Progression
Electrocardiography
Follow-Up Studies
Heart Failure
Humans
Multivariate Analysis
Myocardial Infarction
Percutaneous Coronary Intervention
Prognosis
Proportional Hazards Models
C-Reactive Protein

Figure

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  Fig. 1 Kaplan-Meier analysis according to the statuses of TnI (A), hsCRP (B), NT-proBNP (C), and ST resolution (D). Elevated TnI, hsCRP, and NT-proBNP at initial presentation showed a significantly higher number of major adverse cardiac events (p<0.01 for all). Patients presenting with incomplete ST segment resolution had a significantly worse clinical outcome over the 6-month follow-up (p<0.01). TnI: troponin I, hsCRP: high-sensitivity C-reactive protein, NT-proBNP: N-terminal pro-B-type natriuretic peptide.

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  Fig. 2 Prognostic value of a multi-marker approach. The addition of biochemical markers markedly improved the prognostic utility of the model containing ST-segment resolution. TnI: troponin I, hsCRP: high-sensitivity C-reactive protein, NT-proBNP: N-terminal pro-B-type natriuretic peptide.

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