TY - JOUR
T1 - Prediction of 1-Year Mortality With Different Measures of ST-Segment Recovery in All-Comers After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction
AU - Verouden, Niels J. W.
AU - Haeck, Joost D. E.
AU - Kuijt, Wichert J.
AU - van Geloven, Nan
AU - Koch, Karel T.
AU - Henriques, José P. S.
AU - Baan, Jan
AU - Vis, Marije M.
AU - Piek, Jan J.
AU - Tijssen, Jan G. P.
AU - de Winter, Robbert J.
PY - 2010
Y1 - 2010
N2 - Background-Post hoc analyses from several randomized, controlled trials have established the prognostic importance of different measures of ST-segment recovery in highly selected patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI). In this single-center registry, we investigated whether various measures of ST-segment recovery can be applied to unselected STEMI patients undergoing primary PCI. Methods and Results-We analyzed 12-lead ECGs from 2124 consecutive STEMI patients who underwent primary PCI at our institution between November 1, 2000, and January 1, 2007. ECGs were recorded at the catheterization laboratory immediately before arterial puncture and at the end of PCI. We examined measures assessing ST-segment recovery on the postprocedural ECG and measures comparing both ECGs and related these to 1-year, all-cause mortality. Cumulative ST-segment recovery (Sigma ST-D resolution) at a 50% cutoff had the highest unadjusted accuracy (C statistic, 0.646; 95% confidence interval, 0.602 to 0.689; P <0.001) as compared with the other 8 measures evaluated. Furthermore, Sigma ST-D resolution was the strongest contributor to both the net reclassification and integrated discrimination improvement. Conclusions-Although each measure of ST-segment recovery provided univariable prognostic information, the Sigma ST-D resolution measure comparing summed ST-segment deviations on the preprocedural and postprocedural ECG was the best independent predictor of 1-year mortality in all-comer STEMI patients after primary PCI. (Circ Cardiovasc Qual Outcomes. 2010;3:522-529.)
AB - Background-Post hoc analyses from several randomized, controlled trials have established the prognostic importance of different measures of ST-segment recovery in highly selected patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI). In this single-center registry, we investigated whether various measures of ST-segment recovery can be applied to unselected STEMI patients undergoing primary PCI. Methods and Results-We analyzed 12-lead ECGs from 2124 consecutive STEMI patients who underwent primary PCI at our institution between November 1, 2000, and January 1, 2007. ECGs were recorded at the catheterization laboratory immediately before arterial puncture and at the end of PCI. We examined measures assessing ST-segment recovery on the postprocedural ECG and measures comparing both ECGs and related these to 1-year, all-cause mortality. Cumulative ST-segment recovery (Sigma ST-D resolution) at a 50% cutoff had the highest unadjusted accuracy (C statistic, 0.646; 95% confidence interval, 0.602 to 0.689; P <0.001) as compared with the other 8 measures evaluated. Furthermore, Sigma ST-D resolution was the strongest contributor to both the net reclassification and integrated discrimination improvement. Conclusions-Although each measure of ST-segment recovery provided univariable prognostic information, the Sigma ST-D resolution measure comparing summed ST-segment deviations on the preprocedural and postprocedural ECG was the best independent predictor of 1-year mortality in all-comer STEMI patients after primary PCI. (Circ Cardiovasc Qual Outcomes. 2010;3:522-529.)
U2 - https://doi.org/10.1161/CIRCOUTCOMES.109.923797
DO - https://doi.org/10.1161/CIRCOUTCOMES.109.923797
M3 - Article
C2 - 20716716
SN - 1941-7713
VL - 3
SP - 522
EP - 529
JO - Circulation. Cardiovascular quality and outcomes
JF - Circulation. Cardiovascular quality and outcomes
IS - 5
ER -