045 Predictive factors of ST-segment resolution after primary angioplasty and clinical outcome

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• 作者：Khaldoun Ben Hamda ; Feriel Moatemri ; Hichem Denguir ; Sonia Hamdi ; Mohamed Amine Majdoub ; Sabri Maaoui ; Hamza Thawaba ; Faouzi Maatouk
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：2
• 期：1
• 页码：15
• 全文大小：78 K

文摘

In the setting of acute myocardial infarction (AMI), early resolution of ST-segment elevation was a useful predictor of final infarct size, left ventricular function and clinical outcome.

Aim

to determine the predictive factors of ST-segment resolution immediately following primary coronary angioplasty for AMI.

Methods

primary angioplasty was performed in 270 consecutive patients with first AMI, they were divided into 2 groups according to whether ST-segment resolution occurred 1 hour after the procedure. ST-segment resolution ?70 % was considered as ¡®complete?ST-segment resolution, whereas ST-segment resolution < 70 % was considered as ¡®incomplete?ST-segment resolution.

Results

of the 270 patients, 156 (57.8 % ) had complete ST-segment resolution. Patients with pre-infarction angina had a greater degree of ST-segment resolution than those without angina (71 ¡À21 % vs. 49¡À 43 % , p<0.02).

On multivariate analysis, the absence of pre-infarction angina (OR=2.7; CI 1.7-3.4, p=0.03) as well as the admission after H4 (OR=3.5; CI 1.58-8.06, p=0.002), patient age ?70 year(OR= 5.6; CI 2.23-14.4, p<0.001) and initial TIMI flow grade 0/1 (OR=13.6; CI 4.5-21.2, p<0.001) were major independent predictors of poor ST-segment resolution; whereas sex, coronary risk factors, killip class on admission, multivessel disease and extent of collaterals were not significant.

There was a significant difference in survival free of major adverse cardiovascular events, at multivariate analysis =, incomplete ST-segment resolution was an independent factor of 1-year mortality (p=0.016).

Conclusions

Rapid ST-segment resolution was associated with a better clinical outcome and prognosis after successful primary PTCA. Pre-infarction angina, age < 70 years, TIMI flow 2/3 and ischemia time < 4 hours were associated with a greater degree of ST-segment resolution after primary angioplasty.