ST-Segment Recovery and Outcome After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Insights From the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) Trial

• Published in: Circulation (New York, N.Y.) Vol. 118; no. 13; pp. 1335 - 1346
• Main Authors: Buller, Christopher E., Fu, Yuling, Mahaffey, Kenneth W., Todaro, Thomas G., Adams, Peter, Westerhout, Cynthia M., White, Harvey D., van 't Hof, Arnoud W.J., Van de Werf, Frans J., Wagner, Galen S., Granger, Christopher B., Armstrong, Paul W.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 23.09.2008
• Subjects: Aged; Angioplasty, Balloon, Coronary - mortality; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Combined Modality Therapy; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electrocardiography; Female; Heart; Heart Failure - mortality; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Multivariate Analysis; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Predictive Value of Tests; Prognosis; Recovery of Function; Shock, Cardiogenic - mortality; Single-Chain Antibodies; Treatment Outcome; Myocardial infarction; Prognosis; ST interval; infarction; Cardiovascular disease; Instrumental dilatation; Pexelizumab; Myocardial disease; Coronary heart disease; Percutaneous route; Immunomodulator; ST elevation; Electrocardiography; Apex; angioplasty
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.108.767772

Background— Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining prognosis after primary percutaneous coronary intervention (PCI) would facilitate appropriate care and expedite hospital discharge. Thus, we determined the prognostic importance of various measures of ST-segment–elevation recovery after primary PCI in a large, contemporary cohort of patients with ST-elevation myocardial infarction. Methods and Results— We analyzed ECG data describing the magnitude and extent of ST-segment elevation and deviation before and early after (ie, 30 minutes) primary PCI in the study cohort of 4866 subjects with electrocardiographically high-risk ST-elevation myocardial infarction enrolled in the Assessment of PEXelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Associations among 6 methods for calculating ST-segment recovery, biomarker estimates of infarct size (ie, peak creatine kinase, creatine kinase-MB, and troponin I and T), and prespecified clinical outcomes (ie, rates of 90-day death and 90-day death, heart failure, or shock) were examined. All ST-segment–recovery methods provided strong prognostic information regarding clinical outcomes. A simple ST-segment–recovery method of residual ST-segment elevation measurement in the most affected lead on the post-PCI ECG performed as well as complex methods that required comparison of pre- and post-PCI ECGs or calculation of summed ST-segment deviation in multiple leads (ie, worst-lead residual ST elevation: adjusted hazard ratio for 90-day death rate [reference <1 mm]: 1 to <2 mm, 1.23 [95% CI 0.74 to 2.03]; ≥2 mm, 2.22 [95% CI 1.35 to 3.65], corrected c-index=0.832; 90-day death/congestive heart failure/shock [reference <1 mm]: 1 to <2 mm, 1.55 [95% CI 1.06 to 2.26]; ≥2 mm, 2.33 [95% CI 1.59 to 3.41], corrected c-index=0.802). Biomarker estimates of infarct size declined in association with enhanced ST-segment recovery. Conclusions— An ECG performed early after primary PCI is a simple, widely available, inexpensive, and powerful prognostic tool applicable to patients with ST-elevation myocardial infarction.