Peri-procedural ST segment resolution during Primary Percutaneous Coronary Intervention (PPCI) for acute myocardial infarction: predictors and clinical consequences

Grigoris V Karamasis; Paul Russhard; Firas Al Janabi; Michael Parker; John R Davies; Thomas R Keeble; Gerald J Clesham

doi:10.1016/j.jelectrocard.2017.09.011

Peri-procedural ST segment resolution during Primary Percutaneous Coronary Intervention (PPCI) for acute myocardial infarction: predictors and clinical consequences

J Electrocardiol. 2018 Mar-Apr;51(2):224-229. doi: 10.1016/j.jelectrocard.2017.09.011. Epub 2017 Oct 5.

Authors

Grigoris V Karamasis¹, Paul Russhard², Firas Al Janabi¹, Michael Parker³, John R Davies¹, Thomas R Keeble¹, Gerald J Clesham⁴

Affiliations

¹ Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK.
² Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK.
³ Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK.
⁴ Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK; Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, Essex, UK. Electronic address: Gerald.Clesham@btuh.nhs.uk.

PMID: 29108788
DOI: 10.1016/j.jelectrocard.2017.09.011

Abstract

Objective: ECG ST segment resolution (STR) has been used to assess myocardial perfusion in STEMI patients undergoing PPCI. However, in most of the studies ECGs recorded at different time points after the actual procedure have been used, limiting the options of therapeutic interventions while the patient is still in the catheterisation laboratory. The aim of this study was to investigate the presence and clinical consequences of intra-procedural STR during PPCI.

Methods: We analysed 12 lead ECGs recorded at the onset and the end of the PPCI procedure, measuring STR in the lead with maximum ST elevation on the initial recording. STR was defined as good when > 50% compared to baseline.

Results: Pre and immediately post PPCI ECGs were recorded in 467 STEMI cases whilst the patient was on the catheter lab table. Mean patient age was 63 (+/- 12) years old and 75% were men. Mean duration of symptoms to admission was 3.8 (+/- 3.4) hours and 51% of infarcts were anterior. Good ST resolution at the end of the procedure was seen in 46.5% of patients and was observed more commonly in inferior compared to anterior infarcts (60.1% vs. 32.6%, p<0.001), and in current smokers (53.2% vs. 42.4%, p=0.031). In patients presenting with symptoms for < 4 hours, good STR was more common (74% vs. 66%, p=0.019). Thrombus aspiration was used more frequently in patients who had good STR (88.5% vs 79.8% p=0.011). Patients with good ST resolution had a shorter mean hospital length of stay (3.8 vs. 4.5 days, p=0.009) and a higher left ventricular ejection fraction (49.9% vs. 44.2%, p<0.001) measured by transthoracic echocardiography prior to discharge.

Conclusion: Good peri-procedural ST resolution was seen in less than half of STEMI patients undergoing PPCI. There were important clinical consequences of good ST resolution. Identification of suboptimal peri-procedural ST resolution could help identify patients who may benefit from new treatments aimed at protecting the microcirculation, whilst the patients are still in the angiography laboratory.

Keywords: Acute myocardial infarction; Primary Percutaneous Coronary Intervention; ST segment resolution.

MeSH terms

Electrocardiography*
Female
Humans
Length of Stay / statistics & numerical data
Male
Middle Aged
Percutaneous Coronary Intervention*
Risk Factors
ST Elevation Myocardial Infarction / physiopathology*
ST Elevation Myocardial Infarction / surgery*
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left / physiopathology*
Ventricular Dysfunction, Left / surgery*