Role of ST‐Segment Resolution Alone and in Combination With TIMI Flow After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction
Background To evaluate the role of ST‐segment resolution (STR) alone and in combination with Thrombolysis in Myocardial Infarction (TIMI) flow in reperfusion evaluation after primary percutaneous coronary intervention (PPCI) for ST‐segment–elevation myocardial infarction by investigating the long‐te...
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| Format: | Article |
| Language: | English |
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Wiley
2023-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.029670 |
| _version_ | 1797742599867465728 |
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| author | Chao Wu Xiaojin Gao Ling Li Quanmin Jing Weimin Li Haiyan Xu Wenbo Zhang Sidong Li Yanyan Zhao Yang Wang Wei Li Yongjian Wu Fenghuan Hu Chen Jin Shubin Qiao Jingang Yang Yuejin Yang |
| author_facet | Chao Wu Xiaojin Gao Ling Li Quanmin Jing Weimin Li Haiyan Xu Wenbo Zhang Sidong Li Yanyan Zhao Yang Wang Wei Li Yongjian Wu Fenghuan Hu Chen Jin Shubin Qiao Jingang Yang Yuejin Yang |
| author_sort | Chao Wu |
| collection | DOAJ |
| description | Background To evaluate the role of ST‐segment resolution (STR) alone and in combination with Thrombolysis in Myocardial Infarction (TIMI) flow in reperfusion evaluation after primary percutaneous coronary intervention (PPCI) for ST‐segment–elevation myocardial infarction by investigating the long‐term prognostic impact. Methods and Results From January 2013 through September 2014, we studied 5966 patients with ST‐segment–elevation myocardial infarction enrolled in the CAMI (China Acute Myocardial Infarction) registry with available data of STR evaluated at 120 minutes after PPCI. Successful STR included STR ≥50% and complete STR (ST‐segment back to the equipotential line). After PPCI, the TIMI flow was assessed. The primary outcome was 2‐year all‐cause mortality. STR < 50%, STR ≥50%, and complete STR occurred in 20.6%, 64.3%, and 15.1% of patients, respectively. By multivariable analysis, STR ≥50% (5.6%; adjusted hazard ratio [HR], 0.45 [95% CI, 0.36–0.56]) and complete STR (5.1%; adjusted HR, 0.48 [95% CI, 0.34–0.67]) were significantly associated with lower 2‐year mortality than STR <50% (11.7%). Successful STR was an independent predictor of 2‐year mortality across the spectrum of clinical variables. After combining TIMI flow with STR, different 2‐year mortality was observed in subgroups, with the lowest in successful STR and TIMI 3 flow, intermediate when either of these measures was reduced, and highest when both were abnormal. Conclusions Post‐PPCI STR is a robust long‐term prognosticator for ST‐segment–elevation myocardial infarction, whereas the integrated analysis of STR plus TIMI flow yields incremental prognostic information beyond either measure alone, supporting it as a convenient and reliable surrogate end point for defining successful PPCI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01874691. |
| first_indexed | 2024-03-12T14:43:00Z |
| format | Article |
| id | doaj.art-6e8e8403958447b392e9f560a8175ebd |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-12T14:43:00Z |
| publishDate | 2023-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6e8e8403958447b392e9f560a8175ebd2023-08-16T04:54:43ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-07-01121410.1161/JAHA.123.029670Role of ST‐Segment Resolution Alone and in Combination With TIMI Flow After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial InfarctionChao Wu0Xiaojin Gao1Ling Li2Quanmin Jing3Weimin Li4Haiyan Xu5Wenbo Zhang6Sidong Li7Yanyan Zhao8Yang Wang9Wei Li10Yongjian Wu11Fenghuan Hu12Chen Jin13Shubin Qiao14Jingang Yang15Yuejin Yang16Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaMedical Research and Biometrics Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology General Hospital of Shenyang Military Region Shenyang ChinaDepartment of Cardiology The First Affiliated Hospital of Harbin Medical University Harbin ChinaDepartment of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Epidemiology University Medical Center Groningen Groningen the NetherlandsDivision of Life Sciences and Medicine University of Science and Technology of China Hefei ChinaMedical Research and Biometrics Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaMedical Research and Biometrics Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaMedical Research and Biometrics Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaDepartment of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease National Center for Cardiovascular Diseases Beijing ChinaBackground To evaluate the role of ST‐segment resolution (STR) alone and in combination with Thrombolysis in Myocardial Infarction (TIMI) flow in reperfusion evaluation after primary percutaneous coronary intervention (PPCI) for ST‐segment–elevation myocardial infarction by investigating the long‐term prognostic impact. Methods and Results From January 2013 through September 2014, we studied 5966 patients with ST‐segment–elevation myocardial infarction enrolled in the CAMI (China Acute Myocardial Infarction) registry with available data of STR evaluated at 120 minutes after PPCI. Successful STR included STR ≥50% and complete STR (ST‐segment back to the equipotential line). After PPCI, the TIMI flow was assessed. The primary outcome was 2‐year all‐cause mortality. STR < 50%, STR ≥50%, and complete STR occurred in 20.6%, 64.3%, and 15.1% of patients, respectively. By multivariable analysis, STR ≥50% (5.6%; adjusted hazard ratio [HR], 0.45 [95% CI, 0.36–0.56]) and complete STR (5.1%; adjusted HR, 0.48 [95% CI, 0.34–0.67]) were significantly associated with lower 2‐year mortality than STR <50% (11.7%). Successful STR was an independent predictor of 2‐year mortality across the spectrum of clinical variables. After combining TIMI flow with STR, different 2‐year mortality was observed in subgroups, with the lowest in successful STR and TIMI 3 flow, intermediate when either of these measures was reduced, and highest when both were abnormal. Conclusions Post‐PPCI STR is a robust long‐term prognosticator for ST‐segment–elevation myocardial infarction, whereas the integrated analysis of STR plus TIMI flow yields incremental prognostic information beyond either measure alone, supporting it as a convenient and reliable surrogate end point for defining successful PPCI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01874691.https://www.ahajournals.org/doi/10.1161/JAHA.123.029670acute myocardial infarctionECGoutcomereperfusion |
| spellingShingle | Chao Wu Xiaojin Gao Ling Li Quanmin Jing Weimin Li Haiyan Xu Wenbo Zhang Sidong Li Yanyan Zhao Yang Wang Wei Li Yongjian Wu Fenghuan Hu Chen Jin Shubin Qiao Jingang Yang Yuejin Yang Role of ST‐Segment Resolution Alone and in Combination With TIMI Flow After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute myocardial infarction ECG outcome reperfusion |
| title | Role of ST‐Segment Resolution Alone and in Combination With TIMI Flow After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction |
| title_full | Role of ST‐Segment Resolution Alone and in Combination With TIMI Flow After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction |
| title_fullStr | Role of ST‐Segment Resolution Alone and in Combination With TIMI Flow After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction |
| title_full_unstemmed | Role of ST‐Segment Resolution Alone and in Combination With TIMI Flow After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction |
| title_short | Role of ST‐Segment Resolution Alone and in Combination With TIMI Flow After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction |
| title_sort | role of st segment resolution alone and in combination with timi flow after primary percutaneous coronary intervention for st segment elevation myocardial infarction |
| topic | acute myocardial infarction ECG outcome reperfusion |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.029670 |
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