Korean Circ J.  2009 Aug;39(8):310-316. 10.4070/kcj.2009.39.8.310.

Clinical Predictors of Incomplete ST-Segment Resolution in the Patients With Acute ST Segment Elevation Myocardial Infarction

• Park SR
• Kang YR
• Seo MK
• Kang MK
• Cho JH
• An YJ
• Kwak CH
• Hwang SJ
• Jung YH
• Hwang JY

• KMID: 2225680
• DOI: http://doi.org/10.4070/kcj.2009.39.8.310

Abstract

BACKGROUND AND OBJECTIVES
The failure of ST-segment resolution (STR) after primary percutaneous coronary intervention (pPCI) is associated with adverse clinical outcomes. However, the clinical predictors on admission for incomplete STR are poorly known. SUBJECTS AND METHODS: Patients undergoing pPCI (n=101, 79 males and 22 females, mean age 60.0 years) were divided into complete STR group (> or =70%, n=58) and incomplete STR group (<70%, n=43). The groups were compared according to clinical factors including history, electrocardiographic (ECG) patterns, angiographic features and laboratory data. RESULTS: The incomplete STR group contained more frequent hypertensive patients (p=0.04) and patients displaying longer tendency in total chest pain duration (p=0.08). This group was associated with worse clinical factors such as low ejection fraction (p=0.06), higher Killip class (p=0.08) and more death (p=0.042). Grade 3 ischemia pattern of ECG and precordial ST elevation (i,e anterior myocardial infarction) at admission were more frequent in the incomplete STR group (p=0.001 and 0.002, respectively). Initial troponin I, creatinin kinase -MB and brain natriuretic peptide levels were higher in the incomplete STR group (p=0.001, 0.002, and 0.043, respectively). Coronary angiography showed that culprit lesions were more frequent in left anterior descending artery than other arteries in the incomplete STR group of patients (p=0.002). Thrombolysis In Myocardial Infarction (TIMI) flow grades 2 or less before PCI was more frequent in the incomplete STR group (p=0.029). However, TIMI flow grade after PCI was not appreciably different between the two groups. Logistic regression analysis demonstrated that TIMI flow grade 2 or less was most powerful predictor for incomplete STR {odds ratio (OR)=12.12, 95% confidence interval (CI) 1.23-119.35, p=0.032}. Other independent predictors were anterior infarction (OR=3.39, CI 1.46-10.57, p=0.007), ischemia grade 3 ECG at admission (OR=3.87, CI 1.31-11.41, p=0.014), and hypertensive patients (OR=3.03, CI 1.13-8.15, p=0.027). CONCLUSION: Incomplete STR after pPCI is associated with poor prognostic clinical factors. TIMI flow grade 2 or less before pPCI, ST elevation on precordial leads, ischemia grade 3 pattern of initial ECG, and hypertensive patients are independent predictors for incomplete STR in the early stage.

Keyword

Myocardial infarction; Coronary circulation; Electrocardiography

MeSH Terms

Arteries
Chest Pain
Coronary Angiography
Coronary Circulation
Electrocardiography
Female
Humans
Infarction
Ischemia
Logistic Models
Male
Myocardial Infarction
Natriuretic Peptide, Brain
Percutaneous Coronary Intervention
Phosphotransferases
Troponin I
Natriuretic Peptide, Brain
Phosphotransferases
Troponin I

Figure

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  Fig. 1 ECGs of a patient with inferior STEMI on admission showing grade 3 ischemia. The J point is above 50% of the R wave amplitude in leads III and aVF. ECG: electrocardiography, STEMI: ST elevation myocardial infarction.

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  Fig. 2 ECGs of a patient with anterior STEMI on admission showing grade 2 ischemia. A ST-segment elevation in V1-4 is evident. However, the J point is below 50% of the R wave amplitude in all lead and V1 exhibits a S wave. ECG: electrocardiography, STEMI: ST elevation myocardial infarction.

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