ROLE OF ST SEGMENT RESOLUTION ALONE AND IN COMBINATION WITH THROMBOLYSIS IN MYOCARDIAL INFARCTION (TIMI) FLOW IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

N KHAN; A ULLAH; R ULLAH; U IQBAL; M MAGSI

doi:10.54112/bcsrj.v2023i1.510

Authors

N KHAN Peshawar Institute of Cardiology, Hayatabad, Peshawar, Pakistan
A ULLAH Department of Physiology, Swat Medical College, Pakistan.
R ULLAH Peshawar Institute of Cardiology, Hayatabad, Peshawar, Pakistan
U IQBAL Department of Cardiology, CMH Sialkot, Pakistan
M MAGSI Department of Cardiology, Shaikh Muhammad bin Zayant al Nahyan Institute of Cardiology Quetta Balochistan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.510

Keywords:

ECG, PPCI, STR, Acute Myocardial Infarction

Abstract

This study aimed to assess the effect of ST-segment resolution (STR) alone and in combination with TIMI flow after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). The study was conducted at the Department of Cardiology, Peshawar Institute of Cardiology, Hayatabad Peshawar, KPK, from August 2022 to July 2023. Ninety patients with acute myocardial infarction were enrolled, and STR was considered successful if it reached 50% or complete STR (ST-segment back to the equipotential line). TIMI flow was evaluated after PPCI, and the primary outcome was two-year all-cause mortality. Results showed that each STR <50%, STR ≥50%, and complete STR occurred in 33.3% of the patients. Successful STR was the only independent predictor of 2-year death among all clinical factors. Combining TIMI flow and STR showed different 2-year mortality rates in subgroups; the lowest was seen in successful STR and TIMI 3 flow, the middle when either of these measures was decreased, and the greatest when both were abnormal. The study concluded that analyzing both STR and TIMI flow provides additional prognostic information beyond what either measure could provide. Therefore, it can be used as a reliable and convenient surrogate endpoint for determining successful PPCI. Additionally, the study found that post-PPCI STR is a strong long-term prognosticator for ST-segment elevation myocardial infarction.

Downloads

Download data is not yet available.

References

Anderson, J. L., Adams, C. D., Antman, E. M., Bridges, C. R., Califf, R. M., Casey, D. E., Chavey, W. E., Fesmire, F. M., Hochman, J. S., and Levin, T. N. (2007). ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Journal of the American College of Cardiology 50, e1-e157.

Buller, C. E., Fu, Y., Mahaffey, K. W., Todaro, T. G., Adams, P., Westerhout, C. M., White, H. D., Van't Hof, A. W., Van de Werf, F. J., and Wagner, G. S. (2008). 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. Circulation 118, 1335-1346.

Claeys, M. J., Bosmans, J., Veenstra, L., Jorens, P., De Raedt, H., and Vrints, C. J. (1999). Determinants and prognostic implications of persistent ST-segment elevation after primary angioplasty for acute myocardial infarction: importance of microvascular reperfusion injury on clinical outcome. Circulation 99, 1972-1977.

De Luca, G., Suryapranata, H., Ottervanger, J. P., Hoorntje, J. C., Gosselink, A. M., Dambrink, J.-H., de Boer, M.-J., and van’t Hof, A. W. (2008). Postprocedural single-lead ST-segment deviation and long-term mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty. Heart 94, 44-47.

Elfigih, I. A., and Henein, M. Y. (2014). Non-invasive imaging in detecting myocardial viability: Myocardial function versus perfusion. IJC Heart & Vasculature 5, 51-56.

Fabris, E., and van’t Hof, A. W. (2018). Angiography and electrocardiography (ECG) for the assessment of coronary microvascular obstruction. In "Coronary Microvascular Obstruction in Acute Myocardial Infarction", pp. 109-126. Elsevier.

Lassen, J. F., Bøtker, H. E., and Terkelsen, C. J. (2013). Timely and optimal treatment of patients with STEMI. Nature Reviews Cardiology 10, 41-48.

Matetzky, S., Novikov, M., Gruberg, L., Freimark, D., Feinberg, M., Elian, D., Novikov, I., Di Segni, E., Agranat, O., and Har-Zahav, Y. (1999). The significance of persistent ST elevation versus early resolution of ST segment elevation after primary PTCA. Journal of the American College of Cardiology 34, 1932-1938.

Nowbar, A. N., Gitto, M., Howard, J. P., Francis, D. P., and Al-Lamee, R. (2019). Mortality from ischemic heart disease: Analysis of data from the World Health Organization and coronary artery disease risk factors From NCD Risk Factor Collaboration. Circulation: cardiovascular quality and outcomes 12, e005375.

Palmerini, T., De Servi, S., Politi, A., Martinoni, A., Musumeci, G., Ettori, F., Piccaluga, E., Sangiorgi, D., Lauria, G., and Repetto, A. (2010). Prognostic implications of ST-segment elevation resolution in patients with ST-segment elevation acute myocardial infarction treated with primary or facilitated percutaneous coronary intervention. The American journal of cardiology 105, 605-610.

Sarkar, S. (2013). Dietary intake, lifestyles and risk of nutrition-related non-communicable diseases in a Punjabi south Asian male population in Kent, United Kingdom, University of Greenwich.

Tomaszuk-Kazberuk, A., Kozuch, M., Bachorzewska-Gajewska, H., Malyszko, J., Dobrzycki, S., and Musial, W. J. (2011). Does lack of ST-segment resolution still have prognostic value 6 years after an acute myocardial infarction treated with coronary intervention? Canadian Journal of Cardiology 27, 573-580.

Yaqoob, A., Barolia, R., Ladak, L., Hanif, A., Khan, A. H., and Sahar, W. (2023). Home-based cardiac rehabilitation: development, implementation and outcome evaluation in patients with coronary artery diseases in Lahore, Pakistan–a mixed-methods study protocol. BMJ open 13, e073673.