Importance of ST-Segment Resolution Assessed

Study suggests it may be an important predictor of outcomes at four hours after fibrinolysis
By Eric Metcalf
HealthDay Reporter

WEDNESDAY, Oct. 28 (HealthDay News) -- In patients with ST-segment elevation myocardial infarction (STEMI), ST-segment resolution at four hours after treatment may predict outcomes after fibrinolysis, but has limited prognostic value after primary percutaneous coronary intervention (pPCI), according to the DANish trial in Acute Myocardial Infarction-2 (DANAMI-2) substudy published in the Nov. 3 issue of the Journal of the American College of Cardiology.

Maria Sejersten, M.D., of the Copenhagen University Hospital in Denmark, and colleagues analyzed data from 1,421 patients with STEMI who received pPCI or fibrinolysis. ST-segment elevation was assessed before the intervention, as well as at 90 minutes and four hours post-surgery. The resolution was classified as complete, partial, or no resolution.

The researchers found that the pPCI group had more ST-segment resolution at 90 minutes, but both groups had similar resolution at four hours. Resolution only predicted mortality following fibrinolysis, not pPCI. In addition, the authors note, ST-segment resolution at four hours predicted lower mortality, but higher rates of reinfarction in patients treated with fibrinolysis.

"Our results indicate that ST-segment resolution in the conventional 90-minute and four-hour electrocardiogram remains an important prognostic factor after fibrinolysis, and confirm the clinical utility of these electrocardiograms in selecting patients for rescue PCI," the authors conclude. "The provocative finding of limited prognostic value of ST-segment resolution in a population of STEMI patients treated with pPCI deserves further investigation, especially because it is already widespread as a surrogate end point in trials."

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