Sebastian J Reinstadler1, Anett Baum2, Karl-Philipp Rommel3, Charlotte Eitel2, Steffen Desch2, Meinhard Mende4, Bernhard Metzler5, Janine Poess2, Holger Thiele2, Ingo Eitel2. 1. Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria. 2. Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany. 3. Clinic for Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany. 4. Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany. 5. Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria.
Abstract
OBJECTIVE: ST-elevation myocardial infarction (STEMI) is frequently associated with reciprocal ST-segment depression in contralateral ECG leads. However, the relationship of the resolution of ST-segment depression (STD-R) with myocardial damage is unknown and the potential prognostic value incompletely understood. We sought to evaluate the association between STD-R and markers of myocardial injury as well as to determine the prognostic impact of STD-R in patients with acute reperfused STEMI. METHODS: We enrolled 611 patients with STEMI in this multicentre cardiac magnetic resonance (CMR) study. STD-R, defined as either worsened (<0%), incomplete (0-50%) or complete (≥50%), was determined 90 min after primary percutaneous coronary intervention (PCI). Patients underwent CMR in median 3 (2-4) days after infarction. Major adverse cardiac events (MACE) were defined as a composite of death, reinfarction and new congestive heart failure within 12 months after enrollment. RESULTS: Patients with worsened or incomplete STD-R (n=148 (24.2%)) had a significantly larger area at risk (42 (31-50) vs 37 (29-52) vs 34 (24-46) %LV, p=0.001), larger infarct size (20 (13-30) vs 17(10-26) vs 16 (8-24) %LV, p=0.003), larger extent of microvascular obstruction (0.6(0-3.4) vs 0.4 (0-2.4) vs 0.0 (0-1.4) %LV, p=0.003), and a lower LVEF (46 (39-54) vs 48 (40-56) vs 52 (45-58) %, p<0.001). MACE rate (n=37 (6%)) was significantly higher in patients with worsened (n=10 (19%)) or incomplete STD-R (n=7 (7%)) than in patients with complete STD-R (n=20 (4%), p<0.001). In multivariate Cox regression analysis, categorised STD-R emerged as an independent predictor of MACE at 12 months after adjusting for clinical variables (p=0.007). CONCLUSIONS: Patients with acute STEMI and worsened or incomplete STD-R after PCI show a more pronounced myocardial as well as microvascular damage as detected by CMR with subsequent independent prognostic information on MACE over a 12-month follow-up period. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
RCT Entities:
OBJECTIVE: ST-elevation myocardial infarction (STEMI) is frequently associated with reciprocal ST-segment depression in contralateral ECG leads. However, the relationship of the resolution of ST-segment depression (STD-R) with myocardial damage is unknown and the potential prognostic value incompletely understood. We sought to evaluate the association between STD-R and markers of myocardial injury as well as to determine the prognostic impact of STD-R in patients with acute reperfused STEMI. METHODS: We enrolled 611 patients with STEMI in this multicentre cardiac magnetic resonance (CMR) study. STD-R, defined as either worsened (<0%), incomplete (0-50%) or complete (≥50%), was determined 90 min after primary percutaneous coronary intervention (PCI). Patients underwent CMR in median 3 (2-4) days after infarction. Major adverse cardiac events (MACE) were defined as a composite of death, reinfarction and new congestive heart failure within 12 months after enrollment. RESULTS:Patients with worsened or incomplete STD-R (n=148 (24.2%)) had a significantly larger area at risk (42 (31-50) vs 37 (29-52) vs 34 (24-46) %LV, p=0.001), larger infarct size (20 (13-30) vs 17(10-26) vs 16 (8-24) %LV, p=0.003), larger extent of microvascular obstruction (0.6(0-3.4) vs 0.4 (0-2.4) vs 0.0 (0-1.4) %LV, p=0.003), and a lower LVEF (46 (39-54) vs 48 (40-56) vs 52 (45-58) %, p<0.001). MACE rate (n=37 (6%)) was significantly higher in patients with worsened (n=10 (19%)) or incomplete STD-R (n=7 (7%)) than in patients with complete STD-R (n=20 (4%), p<0.001). In multivariate Cox regression analysis, categorised STD-R emerged as an independent predictor of MACE at 12 months after adjusting for clinical variables (p=0.007). CONCLUSIONS:Patients with acute STEMI and worsened or incomplete STD-R after PCI show a more pronounced myocardial as well as microvascular damage as detected by CMR with subsequent independent prognostic information on MACE over a 12-month follow-up period. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Sebastian Johannes Reinstadler; Hans-Josef Feistritzer; Martin Reindl; Gert Klug; Agnes Mayr; Johannes Mair; Werner Jaschke; Bernhard Metzler Journal: Open Heart Date: 2016-09-20
Authors: Martin Reindl; Sebastian Johannes Reinstadler; Hans-Josef Feistritzer; Markus Theurl; Daniel Basic; Christopher Eigler; Magdalena Holzknecht; Johannes Mair; Agnes Mayr; Gert Klug; Bernhard Metzler Journal: J Am Heart Assoc Date: 2017-10-10 Impact factor: 5.501