Relationship Between ST-Segment Recovery and Clinical Outcomes After Primary Percutaneous Coronary Intervention

DOI Web Site 被引用文献1件
  • Michael E. Farkouh
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • James Reiffel
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Ovidiu Dressler
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Eugenia Nikolsky
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Helen Parise
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Ecatarina Cristea
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • David A. Baran
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Jose Dizon
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Jacques P. Merab
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Alexandra J. Lansky
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Roxana Mehran
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).
  • Gregg W. Stone
    From the Peter Munk Cardias Centre and Heart and Stroke Lewar Centre, Toronto, ON (M.E.F.); Mount Sinai School of Medicine, New York, NY (M.E.F., R.M.); Cardiovascular Research Foundation, New York, NY (M.E.F., J.R., O.D., E.N., H.P., E.C., R.M., G.W.S.); Columbia University Medical Center, New York, NY (J.R., J.D., J.P.M., G.W.S.); Newark Beth Israel Medical Center, Newark, NJ (D.A.B.); and Yale School of Medicine, New Haven, CT (A.J.L.).

書誌事項

タイトル別名
  • The HORIZONS-AMI ECG Substudy Report

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<jats:sec> <jats:title>Background—</jats:title> <jats:p>In patients with ST-segment elevation myocardial infarction undergoing thrombolytic therapy, the degree of ST-segment resolution (STR) correlates with long-term cardiovascular mortality. The long-term predictive value of STR after primary percutaneous coronary intervention (PCI) is less well understood. We sought to determine the long-term prognostic value of STR after primary PCI in ST-segment–elevation myocardial infarction.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> In a formal substudy from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, 2484 patients with ST-segment–elevation myocardial infarction undergoing primary PCI with interpretable baseline and 60-minute post-PCI electrocardiograms had at least 1 mm of baseline ST-segment elevation in ≥2 contiguous leads. Patients were categorized by the degree of STR at 60 minutes: (1) complete (>70%); (2) partial (30%–70%); and (3) absent (<30%). Absent, incomplete, and complete STR were achieved in 514 (20.7%), 712 (28.7%), and 1258 (50.5%) patients, respectively. STR <30% was associated with a greater likelihood of hypertension, diabetes mellitus, longer symptom onset to balloon time, lower left ventricular ejection fraction, and final thrombolysis in myocardial infarction flow <3. At 3 years, patients with STR<30% experienced a higher rate of major adverse cardiovascular events (death, reinfarction, ischemia-driven target vessel revascularization or stroke; 29.9% versus 20.1% versus 19.6%; <jats:italic>P</jats:italic> <0.0001), ischemia-driven target vessel revascularization (20.4% versus 14.0% versus 11.7%; <jats:italic>P</jats:italic> <0.001), and mortality (8.4% versus 5.0% versus 5.6%; <jats:italic>P</jats:italic> =0.03) than those with partial and complete STR, respectively. By multivariable analysis, STR<30% was an independent predictor of 3-year major adverse cardiovascular events (hazard ratio, 1.58; 95% confidence interval, 1.24–2.00; <jats:italic>P</jats:italic> =0.0002) and 3-year ischemia-driven target vessel revascularization (hazard ratio, 1.87; 95% confidence interval, 1.41–2.48; <jats:italic>P</jats:italic> <0.0001). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>In this large international study, absent STR 60 minutes after primary PCI was present in ≈1 in 5 patients with ST-segment–elevation myocardial infarction and was a significant independent predictor of major adverse cardiovascular events and target vessel revascularization at 3 years.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Trial Registration—</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</jats:ext-link> . Unique identifier: NCT00433966 </jats:p> </jats:sec>

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