Continuous ST-monitoring classification in STEMI patients undergoing primary PCI identified three groups with significantly different peak troponin-T levels (1.4, 4.7, and 7.2 microg/L, P<0.001).
Observational (n=92)
Does continuous ST-monitoring classification provide prognostic information in STEMI patients undergoing primary PCI?
Continuous ST-monitoring in the pre- and per-interventional phase can stratify STEMI patients undergoing primary PCI into distinct risk profiles that correlate with infarct size and left ventricular function.
p-value: p=<0.001
AIMS: In patients with ST-elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively. METHODS AND RESULTS: In 92 STEMI patients, continuous ST-monitoring was initiated in the pre-hospital phase and continued during and 90 min following PCI. Patients were divided into three groups: (A) patients achieving spontaneous ST-resolution before PCI; (B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and (C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A (n=22), B (n=43), and C (n=27) differed in peak level of troponin-T (1.4, 4.7, and 7.2 microg/L, P or =70% resolution of ST-elevation (14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters. CONCLUSION: STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.
Terkelsen et al. (2005) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=92). Continuous ST-monitoring classification vs. Traditional 90 min ST-resolution analysis was evaluated on Peak level of troponin-T (p=<0.001). Continuous ST-monitoring classification in STEMI patients undergoing primary PCI identified three groups with significantly different peak troponin-T levels (1.4, 4.7, and 7.2 microg/L, P<0.001).