PMID- 32470531
OWN - NLM
STAT- MEDLINE
DCOM- 20210428
LR  - 20210505
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 319
DP  - 2020 Nov 15
TI  - The high-risk ECG pattern of ST-elevation myocardial infarction: A substudy of 
      the randomized trial of primary PCI with or without routine manual thrombectomy 
      (TOTAL trial).
PG  - 40-45
LID - S0167-5273(20)31075-5 [pii]
LID - 10.1016/j.ijcard.2020.05.053 [doi]
AB  - BACKGROUND: Useful tools for risk assessment in patients with STEMI are needed. 
      We evaluated the prognostic impact of the evolving myocardial infarction (EMI) 
      and the preinfarction syndrome (PIS) ECG patterns and determined their 
      correlation with angiographic findings and treatment strategy. METHODS: This 
      substudy of the randomized Trial of Routine Aspiration Thrombectomy with PCI 
      versus PCI Alone in Patients with STEMI (TOTAL) included 7860 patients with STEMI 
      and either the EMI or the PIS ECG pattern. The primary outcome was a composite of 
      death from cardiovascular causes, recurrent MI, cardiogenic shock, or New York 
      Heart Association (NYHA) class IV heart failure within one year. RESULTS: The 
      primary outcome occurred in 271 of 2618 patients (10.4%) in the EMI group vs. 322 
      of 5242 patients (6.1%) in the PIS group [AdjustedHR, 1.54; 95% CI, 1.30 to 1.82; 
      p < .001]. The primary outcome occurred in the thrombectomy and PCI alone groups 
      in 131 of 1306 (10.0%) and 140 of 1312 (10.7%) patients with EMI [HR 0.94; 95% 
      CI, 0.74-1.19] and 162 of 2633 (6.2%) and 160 of 2609 (6.1%) patients with PIS 
      [HR 1.00; 95% CI, 0.81-1.25], respectively (p(interaction) = 0.679). CONCLUSIONS: 
      Patients with the EMI ECG pattern proved to have an increased rate of the primary 
      outcome within one year compared to the PIS pattern. Routine manual thrombectomy 
      did not reduce the risk of primary outcome within the different dynamic ECG 
      patterns. The PIS/EMI dynamic ECG classification could help to triage patients in 
      case of simultaneous STEMI patients with immediate need for pPCI.
CI  - Copyright (c) 2020 Elsevier B.V. All rights reserved.
FAU - Leivo, Joonas
AU  - Leivo J
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Finland; 
      Faculty of Medicine and Health Technology, Tampere University, Finnish 
      Cardiovascular Research Center, Tampere, Finland. Electronic address: 
      joonas.leivo@fimnet.fi.
FAU - Anttonen, Eero
AU  - Anttonen E
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Finland; 
      Faculty of Medicine and Health Technology, Tampere University, Finnish 
      Cardiovascular Research Center, Tampere, Finland.
FAU - Jolly, Sanjit S
AU  - Jolly SS
AD  - Population Health Research Institute, Hamilton, Canada; Department of Medicine, 
      McMaster University, Hamilton, Canada; Hamilton Health Sciences, Hamilton, 
      Canada.
FAU - Dzavik, Vladimir
AU  - Dzavik V
AD  - Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
FAU - Koivumaki, Jyri
AU  - Koivumaki J
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Finland.
FAU - Tahvanainen, Minna
AU  - Tahvanainen M
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Finland.
FAU - Koivula, Kimmo
AU  - Koivula K
AD  - Faculty of Medicine and Health Technology, Tampere University, Finnish 
      Cardiovascular Research Center, Tampere, Finland; Internal medicine, Helsinki 
      University Hospital, Finland.
FAU - Nikus, Kjell
AU  - Nikus K
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Finland; 
      Faculty of Medicine and Health Technology, Tampere University, Finnish 
      Cardiovascular Research Center, Tampere, Finland.
FAU - Wang, Jia
AU  - Wang J
AD  - Population Health Research Institute, Hamilton, Canada; Department of Medicine, 
      McMaster University, Hamilton, Canada; David Braley Cardiac, Vascular and Stroke 
      Research Institute, Hamilton, Canada.
FAU - Cairns, John A
AU  - Cairns JA
AD  - University of British Columbia, Vancouver, Canada.
FAU - Niemela, Kari
AU  - Niemela K
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Finland.
FAU - Eskola, Markku J
AU  - Eskola MJ
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Finland; 
      Faculty of Medicine and Health Technology, Tampere University, Finnish 
      Cardiovascular Research Center, Tampere, Finland.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20200526
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
SB  - IM
CIN - Int J Cardiol. 2020 Dec 15;321:20-21. PMID: 32629003
MH  - *Coronary Thrombosis
MH  - Electrocardiography
MH  - Humans
MH  - *Percutaneous Coronary Intervention
MH  - *ST Elevation Myocardial Infarction/diagnostic imaging/surgery
MH  - Thrombectomy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - ECG
OT  - Evolving myocardial infarction
OT  - Preinfarction syndrome
OT  - Q wave
OT  - STEMI
OT  - T wave inversion
EDAT- 2020/05/30 06:00
MHDA- 2021/04/29 06:00
CRDT- 2020/05/30 06:00
PHST- 2020/03/03 00:00 [received]
PHST- 2020/05/14 00:00 [revised]
PHST- 2020/05/18 00:00 [accepted]
PHST- 2020/05/30 06:00 [pubmed]
PHST- 2021/04/29 06:00 [medline]
PHST- 2020/05/30 06:00 [entrez]
AID - S0167-5273(20)31075-5 [pii]
AID - 10.1016/j.ijcard.2020.05.053 [doi]
PST - ppublish
SO  - Int J Cardiol. 2020 Nov 15;319:40-45. doi: 10.1016/j.ijcard.2020.05.053. Epub 
      2020 May 26.