PMID- 38109987
OWN - NLM
STAT- MEDLINE
DCOM- 20240219
LR  - 20240219
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 269
DP  - 2024 Mar
TI  - The prognostic significance of single-lead ST-segment resolution in ST-segment 
      elevation myocardial infarction patients treated with primary PCI - A substudy of 
      the randomized TOTAL trial.
PG  - 149-157
LID - S0002-8703(23)00347-2 [pii]
LID - 10.1016/j.ahj.2023.12.009 [doi]
AB  - BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is associated with 
      high morbidity and mortality worldwide. Simple electrocardiogram (ECG) tools, 
      including ST-segment resolution (STR) have been developed to identify high-risk 
      STEMI patients after primary percutaneous coronary intervention (PCI). SUBJECTS 
      AND METHODS: We evaluated the prognostic impact of STR in the ECG lead with 
      maximal baseline ST-segment elevation (STE) 30-60 minutes after primary PCI in 
      7,654 STEMI patients included in the TOTAL trial. Incomplete or no STR was 
      defined as < 70% STR and complete STR as >/= 70% STR. The primary outcome was the 
      composite of cardiovascular death, recurrent myocardial infarction (MI), 
      cardiogenic shock, or new or worsening New York Heart Association (NYHA) class IV 
      heart failure at 1-year follow-up. RESULTS: Of 7,654 patients, 42.9% had 
      incomplete or no STR and 57.1% had complete STR. The primary outcome occurred in 
      341 patients (10.4%) in the incomplete or no STR group and in 234 patients (5.4%) 
      in the complete STR group. In Cox regression analysis, adjusted hazard ratio for 
      STR < 70% to predict the primary outcome was 1.56 (95% confidence interval 
      1.32-1.89; P < .001) (model adjusted for all baseline comorbidities, clinical 
      status during hospitalization, angiographic findings, and procedural techniques). 
      CONCLUSION: In a large international study of STEMI patients, STR < 70% 30-60 
      minutes post primary PCI in the ECG lead with the greatest STE at admission was 
      associated with an increased rate of the composite of cardiovascular death, 
      recurrent MI, cardiogenic shock, or new or worsening NYHA class IV heart failure 
      at 1-year follow-up. Clinicians should pay attention to this simple ECG finding.
CI  - Copyright (c) 2023 The Author(s). Published by Elsevier Inc. All rights reserved.
FAU - Siren, Marko
AU  - Siren M
AD  - Faculty of Medicine and Health Technology and Finnish Cardiovascular Research 
      Center, Tampere University, Tampere, Finland. Electronic address: 
      marko.siren@tuni.fi.
FAU - Leivo, Joonas
AU  - Leivo J
AD  - Faculty of Medicine and Health Technology and Finnish Cardiovascular Research 
      Center, Tampere University, Tampere, Finland; Heart Center, Department of 
      Cardiology, Tampere University Hospital, Tampere, Finland.
FAU - Anttonen, Eero
AU  - Anttonen E
AD  - Paijat-sote, Primary health care, Lahti, 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, Tampere, 
      Finland.
FAU - Tahvanainen, Minna
AU  - Tahvanainen M
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, 
      Finland.
FAU - Koivula, Kimmo
AU  - Koivula K
AD  - Internal medicine, South Karelia Central Hospital, Lappeenranta, 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  - The University of British Columbia, Vancouver, Canada.
FAU - Niemela, Kari
AU  - Niemela K
AD  - Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, 
      Finland.
FAU - Eskola, Markku
AU  - Eskola M
AD  - Faculty of Medicine and Health Technology and Finnish Cardiovascular Research 
      Center, Tampere University, Tampere, Finland; Heart Center, Department of 
      Cardiology, Tampere University Hospital, Tampere, Finland.
FAU - Nikus, Kjell C
AU  - Nikus KC
AD  - Faculty of Medicine and Health Technology and Finnish Cardiovascular Research 
      Center, Tampere University, Tampere, Finland; Heart Center, Department of 
      Cardiology, Tampere University Hospital, Tampere, Finland.
FAU - Hernesniemi, Jussi
AU  - Hernesniemi J
AD  - Faculty of Medicine and Health Technology and Finnish Cardiovascular Research 
      Center, Tampere University, Tampere, Finland; Heart Center, Department of 
      Cardiology, Tampere University Hospital, Tampere, Finland.
LA  - eng
PT  - Journal Article
DEP - 20231216
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Humans
MH  - Prognosis
MH  - *ST Elevation Myocardial Infarction/diagnosis/surgery/etiology
MH  - *Percutaneous Coronary Intervention/adverse effects
MH  - Shock, Cardiogenic/etiology
MH  - *Myocardial Infarction/diagnosis/surgery
MH  - Electrocardiography
MH  - *Heart Failure/etiology
MH  - Treatment Outcome
COIS- Disclosures None reported
EDAT- 2023/12/19 00:41
MHDA- 2024/02/19 06:42
CRDT- 2023/12/18 19:24
PHST- 2023/10/27 00:00 [received]
PHST- 2023/11/21 00:00 [revised]
PHST- 2023/12/11 00:00 [accepted]
PHST- 2024/02/19 06:42 [medline]
PHST- 2023/12/19 00:41 [pubmed]
PHST- 2023/12/18 19:24 [entrez]
AID - S0002-8703(23)00347-2 [pii]
AID - 10.1016/j.ahj.2023.12.009 [doi]
PST - ppublish
SO  - Am Heart J. 2024 Mar;269:149-157. doi: 10.1016/j.ahj.2023.12.009. Epub 2023 Dec 
      16.