Original Research Cardiology 2014;128:273–281 DOI: 10.1159/000362438
Received: February 25, 2014 Accepted after revision: March 25, 2014 Published online: May 28, 2014
Predictors and Clinical Implications of Minimal ST-Segment Elevation in Patients with ST-Segment Elevation Myocardial Infarction Se Yong Jang Myung Hwan Bae Jae Hee Kim Sun Hee Park Jang Hoon Lee Dong Heon Yang Hun Sik Park Yongkeun Cho Shung Chull Chae Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
Abstract Objectives: Some patients with suspected ST-segment elevation (STE) myocardial infarction (STEMI) show STE that does not fulfill the current criteria for STEMI. The purpose of this study was to investigate the characteristics and prognoses of patients with minimal STEMI. Methods: Between November 2007 and December 2011, 546 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were enrolled. Results: The minimal STE group had a higher proportion of women (30.2 vs. 21.0%, p = 0.031), better pre-PCI antegrade flow (Thrombolysis in Myocardial Infarction flow 2–3, 30.2 vs. 18.8%, p = 0.006) and better collateralization (Rentrop score 2–3, 27.4 vs. 18.1%, p = 0.024) compared to the definite STE group. Multivariate analysis showed that each of them were independent predictors for minimal STE. However, 1-year mortality of the minimal STE group did not differ from that of the definite STE group (7.1 vs. 9.3%, log-rank p = 0.315). Conclusions: Female gender, good collateral flow and good pre-PCI antegrade flow were
© 2014 S. Karger AG, Basel 0008–6312/14/1283–0273$39.50/0 E-Mail [email protected] www.karger.com/crd
independent predictors for minimal STE in patients with STEMI. However, minimal STE was not related to a good prognosis in patients with STEMI. © 2014 S. Karger AG, Basel
Introduction
Reperfusion therapy plays an essential role in improving the prognoses of patients with ST-segment elevation (STE) myocardial infarction (STEMI) [1]. Rapid diagnosis is a major concern when managing patients with STEMI, and the electrocardiogram (ECG) plays an integral part in such diagnoses. In STEMI diagnosis, the cutpoints applied for STE depend on gender and age, since ST-segment amplitude is known to be variable depending on gender and age [2]. Furthermore, because of such variations, some patients clinically assumed to have STEMI often do not fulfill the ECG criteria for STEMI. However, little is known about the incidence of minimal STEMI or the characteristics of patients with minimal STE. In addition, the clinical implications of minimal STE are not established in this era of percutaneous coronary intervention (PCI) as compared with those of guideline-fulMyung Hwan Bae, MD, PhD Department of Internal Medicine Kyungpook National University Hospital 130 Dongdeok-ro, Jung-gu, Daegu 700-721 (Republic of Korea) E-Mail bmh0325 @ knu.ac.kr
Downloaded by: University of Florida, Gainesville and Jacksonville 128.227.24.141 - 11/27/2017 6:47:25 AM
Key Words Minimal ST-segment elevation · Myocardial infarction · Prognosis
Color version available online
a
b Fig. 1. Examples of minimal STE. a A coronary angiogram showed total occlusion in the left anterior descending artery. However, the ECG showed minimal STE 11.5, ≤20.5) 3rd tertile (>20.5) Proximal lesion Post-PCI TIMI 3 flow
All (n = 546)
Definite STE (n = 420)
Minimal STE (n = 126)
p value
62.1 ± 12.1 126 (23.1) 165.5 ± 8.3 64.8 ± 11.1 23.6 ± 3.0 128.7 ± 30.8 78.5 ± 20.1
62.0 ± 12.2 88 (21.0) 165.9 ± 8.0 65.0 ± 11.1 23.5 ± 2.9 128.5 ± 31.2 79.3 ± 20.3
62.5 ± 12.0 38 (30.2) 164.1 ± 9.2 64.1 ± 11.1 23.7 ± 3.2 129.1 ± 29.7 75.8 ± 19.1
0.717 0.031 0.056 0.441 0.462 0.850 0.088 0.926
422 (77.3) 124 (22.7) 7 (1.3) 239 (43.8) 119 (21.8) 17 (3.1) 49.3 ± 10.7 251.7 ± 145.8 185.4 ± 141.2 66.4 ± 39.3 84.1 ± 34.1
325 (77.4) 95 (22.6) 6 (1.4) 187 (44.5) 88 (21.0) 14 (3.3) 49.2 ± 10.9 249.4 ± 143.8 187.1 ± 141.1 62.3 ± 32.6 84.3 ± 33.7
97 (77.0) 29 (23.0) 1 (1.6) 52 (41.3) 31 (24.6) 3 (2.4) 49.5 ± 10.2 259.7 ± 152.7 179.6 ± 142.0 80.1 ± 53.9 83.4 ± 35.6
1.000 0.518 0.384 0.438 0.808 0.485 0.485 0.001 0.791
3.75 ± 1.54 8.62 ± 7.83 2.04 ± 1.32 226 (41.4) 374 (68.5)
4.14 ± 1.44 10.59 ± 7.78 2.41 ± 1.26 183 (43.6%) 300 (71.4)
2.42 ± 1.04 2.07 ± 2.84 0.80 ± 0.48 43 (34.1) 74 (58.7)
Received: February 25, 2014 Accepted after revision: March 25, 2014 Published online: May 28, 2014
Predictors and Clinical Implications of Minimal ST-Segment Elevation in Patients with ST-Segment Elevation Myocardial Infarction Se Yong Jang Myung Hwan Bae Jae Hee Kim Sun Hee Park Jang Hoon Lee Dong Heon Yang Hun Sik Park Yongkeun Cho Shung Chull Chae Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
Abstract Objectives: Some patients with suspected ST-segment elevation (STE) myocardial infarction (STEMI) show STE that does not fulfill the current criteria for STEMI. The purpose of this study was to investigate the characteristics and prognoses of patients with minimal STEMI. Methods: Between November 2007 and December 2011, 546 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were enrolled. Results: The minimal STE group had a higher proportion of women (30.2 vs. 21.0%, p = 0.031), better pre-PCI antegrade flow (Thrombolysis in Myocardial Infarction flow 2–3, 30.2 vs. 18.8%, p = 0.006) and better collateralization (Rentrop score 2–3, 27.4 vs. 18.1%, p = 0.024) compared to the definite STE group. Multivariate analysis showed that each of them were independent predictors for minimal STE. However, 1-year mortality of the minimal STE group did not differ from that of the definite STE group (7.1 vs. 9.3%, log-rank p = 0.315). Conclusions: Female gender, good collateral flow and good pre-PCI antegrade flow were
© 2014 S. Karger AG, Basel 0008–6312/14/1283–0273$39.50/0 E-Mail [email protected] www.karger.com/crd
independent predictors for minimal STE in patients with STEMI. However, minimal STE was not related to a good prognosis in patients with STEMI. © 2014 S. Karger AG, Basel
Introduction
Reperfusion therapy plays an essential role in improving the prognoses of patients with ST-segment elevation (STE) myocardial infarction (STEMI) [1]. Rapid diagnosis is a major concern when managing patients with STEMI, and the electrocardiogram (ECG) plays an integral part in such diagnoses. In STEMI diagnosis, the cutpoints applied for STE depend on gender and age, since ST-segment amplitude is known to be variable depending on gender and age [2]. Furthermore, because of such variations, some patients clinically assumed to have STEMI often do not fulfill the ECG criteria for STEMI. However, little is known about the incidence of minimal STEMI or the characteristics of patients with minimal STE. In addition, the clinical implications of minimal STE are not established in this era of percutaneous coronary intervention (PCI) as compared with those of guideline-fulMyung Hwan Bae, MD, PhD Department of Internal Medicine Kyungpook National University Hospital 130 Dongdeok-ro, Jung-gu, Daegu 700-721 (Republic of Korea) E-Mail bmh0325 @ knu.ac.kr
Downloaded by: University of Florida, Gainesville and Jacksonville 128.227.24.141 - 11/27/2017 6:47:25 AM
Key Words Minimal ST-segment elevation · Myocardial infarction · Prognosis
Color version available online
a
b Fig. 1. Examples of minimal STE. a A coronary angiogram showed total occlusion in the left anterior descending artery. However, the ECG showed minimal STE 11.5, ≤20.5) 3rd tertile (>20.5) Proximal lesion Post-PCI TIMI 3 flow
All (n = 546)
Definite STE (n = 420)
Minimal STE (n = 126)
p value
62.1 ± 12.1 126 (23.1) 165.5 ± 8.3 64.8 ± 11.1 23.6 ± 3.0 128.7 ± 30.8 78.5 ± 20.1
62.0 ± 12.2 88 (21.0) 165.9 ± 8.0 65.0 ± 11.1 23.5 ± 2.9 128.5 ± 31.2 79.3 ± 20.3
62.5 ± 12.0 38 (30.2) 164.1 ± 9.2 64.1 ± 11.1 23.7 ± 3.2 129.1 ± 29.7 75.8 ± 19.1
0.717 0.031 0.056 0.441 0.462 0.850 0.088 0.926
422 (77.3) 124 (22.7) 7 (1.3) 239 (43.8) 119 (21.8) 17 (3.1) 49.3 ± 10.7 251.7 ± 145.8 185.4 ± 141.2 66.4 ± 39.3 84.1 ± 34.1
325 (77.4) 95 (22.6) 6 (1.4) 187 (44.5) 88 (21.0) 14 (3.3) 49.2 ± 10.9 249.4 ± 143.8 187.1 ± 141.1 62.3 ± 32.6 84.3 ± 33.7
97 (77.0) 29 (23.0) 1 (1.6) 52 (41.3) 31 (24.6) 3 (2.4) 49.5 ± 10.2 259.7 ± 152.7 179.6 ± 142.0 80.1 ± 53.9 83.4 ± 35.6
1.000 0.518 0.384 0.438 0.808 0.485 0.485 0.001 0.791
3.75 ± 1.54 8.62 ± 7.83 2.04 ± 1.32 226 (41.4) 374 (68.5)
4.14 ± 1.44 10.59 ± 7.78 2.41 ± 1.26 183 (43.6%) 300 (71.4)
2.42 ± 1.04 2.07 ± 2.84 0.80 ± 0.48 43 (34.1) 74 (58.7)
