Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction

Department of Cardiology, Free University Berlin, Germany.

OBJECTIVES. This study proposed to verify the prognostic power of early ST segment elevation resolution in patients with acute myocardial infarction from the Intravenous Streptokinase in Acute Myocardial Infarction study data base. BACKGROUND. Data from a small prospective study suggested that use of two cutoff points for three different levels of ST segment resolution 3 h after the start of thrombolysis may be an efficient way to predict outcome in an individual patient. METHODS. The three groups of ST segment resolution were defined as 1) complete resolution (> or = 70% [552 patients]) or only slight ST segment elevation (127 patients); 2) partial resolution (< 70% to 30% [475 patients]); 3) no resolution (< 30% to > 0% [362 patients]). Infarct size was measured from creatine kinase isoenzyme, MB fraction, release and from the number of Q waves. Left ventricular function was assessed in 818 patients 1 month after infarction. RESULTS. For complete, partial and no ST segment resolution 3 h after the start of streptokinase or placebo infusion, enzyme release was 1.2, 1.8 and 2.1 IU/ml x h; number of Q waves 1.7, 2.5 and 3.0; and ejection fraction 60%, 53% and 49%, respectively (all adjusted p = 0.0000). Mortality rate at 21 days was 2.2%, 3.4% and 8.6%, respectively. No ST segment resolution was the most powerful independent predictor of early mortality (p = 0.0001). Survival rate curves at 6-year follow-up showed significant mortality differences with increasing divergence (p = 0.0003 anterior infarction; p = 0.005 inferior infarction). In subgroups with an overall higher risk of dying, mortality was strongly determined by the extent of early ST segment resolution. CONCLUSIONS. The extent of ST segment elevation resolution conveys useful early information about outcome in an individual patient after acute myocardial infarction.

This article has been cited by other articles:

				G. Niccoli, S. Giubilato, E. Russo, C. Spaziani, A. Leo, I. Porto, A. M. Leone, F. Burzotta, S. Riondino, F. Pulcinelli, et al. Plasma levels of thromboxane A2 on admission are associated with no-reflow after primary percutaneous coronary intervention Eur. Heart J., August 1, 2008; 29(15): 1843 - 1850. [Abstract] [Full Text] [PDF]

				Y. Ikari, M. Sakurada, K. Kozuma, S. Kawano, T. Katsuki, K. Kimura, T. Suzuki, T. Yamashita, A. Takizawa, K. Misumi, et al. Upfront Thrombus Aspiration in Primary Coronary Intervention for Patients With ST-Segment Elevation Acute Myocardial Infarction: Report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) Trial J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 424 - 431. [Abstract] [Full Text] [PDF]

				R. Nijveldt, A. M. Beek, A. Hirsch, M. G. Stoel, M. B.M. Hofman, V. A.W.M. Umans, P. R. Algra, J. W.R. Twisk, and A. C. van Rossum Functional recovery after acute myocardial infarction comparison between angiography, electrocardiography, and cardiovascular magnetic resonance measures of microvascular injury. J. Am. Coll. Cardiol., July 15, 2008; 52(3): 181 - 189. [Abstract] [Full Text] [PDF]

				M. S. Sabatine, D. A. Morrow, L. J. Higgins, C. MacGillivray, W. Guo, C. Bode, N. Rifai, C. P. Cannon, R. E. Gerszten, and R. T. Lee Complementary Roles for Biomarkers of Biomechanical Strain ST2 and N-Terminal Prohormone B-Type Natriuretic Peptide in Patients With ST-Elevation Myocardial Infarction Circulation, April 15, 2008; 117(15): 1936 - 1944. [Abstract] [Full Text] [PDF]

				M. O'Donoghue, D. A. Morrow, C. P. Cannon, W. Guo, S. A. Murphy, C. M. Gibson, and M. S. Sabatine Association between baseline neutrophil count, clopidogrel therapy, and clinical and angiographic outcomes in patients with ST-elevation myocardial infarction receiving fibrinolytic therapy Eur. Heart J., April 2, 2008; 29(8): 984 - 991. [Abstract] [Full Text] [PDF]

				M. A. McDonald, Y. Fu, U. Zeymer, G. Wagner, S. G. Goodman, A. Ross, C. B. Granger, F. Van de Werf, P. W. Armstrong, and for the ASSENT-4 PCI Investigators Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy Eur. Heart J., April 1, 2008; 29(7): 871 - 879. [Abstract] [Full Text] [PDF]

				M Toma, Y Fu, G Wagner, S G Goodman, C Granger, L Wallentin, F Van de Werf, and P Armstrong Risk stratification in ST-elevation myocardial infarction is enhanced by combining baseline ST deviation and subsequent ST-segment resolution Heart, March 1, 2008; 94(3): e6 - e6. [Abstract] [Full Text] [PDF]

				G De Luca, H Suryapranata, J P Ottervanger, J C A Hoorntje, A T M Gosselink, J-H Dambrink, M-J de Boer, and A W J v. Hof Postprocedural single-lead ST-segment deviation and long-term mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty Heart, January 1, 2008; 94(1): 44 - 47. [Abstract] [Full Text] [PDF]

				L A Pierard ST elevation after myocardial infarction: what does it mean? Heart, November 1, 2007; 93(11): 1329 - 1330. [Abstract] [Full Text] [PDF]

				J. Zalewski, A. Undas, J. Godlewski, E. Stepien, and K. Zmudka No-Reflow Phenomenon After Acute Myocardial Infarction Is Associated With Reduced Clot Permeability and Susceptibility to Lysis Arterioscler. Thromb. Vasc. Biol., October 1, 2007; 27(10): 2258 - 2265. [Abstract] [Full Text] [PDF]

				B. M. Scirica, D. A. Morrow, Z. Sadowski, M. Ruda, J. C. Nicolau, R. P. Giugliano, S. D. Wiviott, M. S. Sabatine, A. Shui, E. M. Antman, et al. A strategy of using enoxaparin as adjunctive antithrombin therapy reduces death and recurrent myocardial infarction in patients who achieve early ST-segment resolution after fibrinolytic therapy: the ExTRACT-TIMI 25 ECG study Eur. Heart J., September 1, 2007; 28(17): 2070 - 2076. [Abstract] [Full Text] [PDF]

				E. Eeckhout RESCUE PERCUTANEOUS CORONARY INTERVENTION: DOES THE CONCEPT MAKE SENSE? Heart, May 1, 2007; 93(5): 632 - 638. [Full Text] [PDF]

				F. Fernandez-Aviles, J. J. Alonso, G. Pena, J. Blanco, J. Alonso-Briales, J. Lopez-Mesa, F. Fernandez-Vazquez, J. Moreu, R. A. Hernandez, A. Castro-Beiras, et al. Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation: the GRACIA-2 non-inferiority, randomized, controlled trial Eur. Heart J., April 2, 2007; 28(8): 949 - 960. [Abstract] [Full Text] [PDF]

				B. Amasyali, K. Aytemir, S. Kose, A. Kilic, G. Abali, A. Iyisoy, H. Kursaklioglu, M. Turan, N. Bingol, E. Isik, et al. Admission Plasma Leptin Level Strongly Correlates With the Success of Thrombolytic Therapy in Patients With Acute Myocardial Infarction Angiology, January 1, 2007; 57(6): 671 - 680. [Abstract] [PDF]

				P. Silva-Orrego, P. Colombo, R. Bigi, D. Gregori, A. Delgado, P. Salvade, J. Oreglia, P. Orrico, A. de Biase, G. Piccalo, et al. Thrombus Aspiration Before Primary Angioplasty Improves Myocardial Reperfusion in Acute Myocardial Infarction: The DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) Study J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1552 - 1559. [Abstract] [Full Text] [PDF]

				A. Ali, D. Cox, N. Dib, B. Brodie, D. Berman, N. Gupta, K. Browne, R. Iwaoka, M. Azrin, D. Stapleton, et al. Rheolytic Thrombectomy With Percutaneous Coronary Intervention for Infarct Size Reduction in Acute Myocardial Infarction: 30-Day Results From a Multicenter Randomized Study J. Am. Coll. Cardiol., July 18, 2006; 48(2): 244 - 252. [Abstract] [Full Text] [PDF]

				B. M. Scirica, M. S. Sabatine, D. A. Morrow, C. M. Gibson, S. A. Murphy, S. D. Wiviott, R. P. Giugliano, C. H. McCabe, C. P. Cannon, and E. Braunwald The Role of Clopidogrel in Early and Sustained Arterial Patency After Fibrinolysis for ST-Segment Elevation Myocardial Infarction: The ECG CLARITY-TIMI 28 Study J. Am. Coll. Cardiol., July 4, 2006; 48(1): 37 - 42. [Abstract] [Full Text] [PDF]

				A. Kaltoft, M. Bottcher, S. S. Nielsen, H.-H. T. Hansen, C. Terkelsen, M. Maeng, J. Kristensen, L. Thuesen, L. R. Krusell, S. D. Kristensen, et al. Routine Thrombectomy in Percutaneous Coronary Intervention for Acute ST-Segment-Elevation Myocardial Infarction: A Randomized, Controlled Trial Circulation, July 4, 2006; 114(1): 40 - 47. [Abstract] [Full Text] [PDF]

				M. Suzuki, T. Sakaue, M. Tanaka, E. Hirose, H. Saeki, T. Matsunaka, S. Hiramatsu, and Y. Kazatani Association Between Right Bundle Branch Block and Impaired Myocardial Tissue-Level Reperfusion in Patients With Acute Myocardial Infarction J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2122 - 2124. [Full Text] [PDF]

				A Prasad and B J Gersh Management of microvascular dysfunction and reperfusion injury Heart, December 1, 2005; 91(12): 1530 - 1532. [Full Text] [PDF]

				P. Johanson, Y. Fu, S. G. Goodman, M. Dellborg, P. W. Armstrong, M. W. Krucoff, L. Wallentin, and G. S. Wagner A dynamic model forecasting myocardial infarct size before, during, and after reperfusion therapy: an ASSENT-2 ECG/VCG substudy Eur. Heart J., September 1, 2005; 26(17): 1726 - 1733. [Abstract] [Full Text] [PDF]

				P. Sorajja, B. J. Gersh, C. Costantini, M. G. McLaughlin, P. Zimetbaum, D. A. Cox, E. Garcia, J. E. Tcheng, R. Mehran, A. J. Lansky, et al. Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction Eur. Heart J., April 1, 2005; 26(7): 667 - 674. [Abstract] [Full Text] [PDF]

				G. W. Stone, J. Webb, D. A. Cox, B. R. Brodie, M. Qureshi, A. Kalynych, M. Turco, H. P. Schultheiss, D. Dulas, B. D. Rutherford, et al. Distal Microcirculatory Protection During Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Trial JAMA, March 2, 2005; 293(9): 1063 - 1072. [Abstract] [Full Text] [PDF]

				A. Prasad, G. W. Stone, T. D. Stuckey, C. O. Costantini, P. J. Zimetbaum, M. McLaughlin, R. Mehran, E. Garcia, J. E. Tcheng, D. A. Cox, et al. Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction J. Am. Coll. Cardiol., February 15, 2005; 45(4): 508 - 514. [Abstract] [Full Text] [PDF]

				L Bhatia, G J Clesham, and D R Turner Clinical implications of ST-segment non-resolution after thrombolysis for myocardial infarction J R Soc Med, December 1, 2004; 97(12): 566 - 570. [Abstract] [Full Text] [PDF]

				R. Schroder Prognostic Impact of Early ST-Segment Resolution in Acute ST-Elevation Myocardial Infarction Circulation, November 23, 2004; 110(21): e506 - e510. [Full Text] [PDF]

				B. J. Drew, R. M. Califf, M. Funk, E. S. Kaufman, M. W. Krucoff, M. M. Laks, P. W. Macfarlane, C. Sommargren, S. Swiryn, and G. F. Van Hare Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses Circulation, October 26, 2004; 110(17): 2721 - 2746. [Abstract] [Full Text] [PDF]

				M. G. McLaughlin, G. W. Stone, E. Aymong, G. Gardner, R. Mehran, A. J. Lansky, C. L. Grines, J. E. Tcheng, D. A. Cox, T. Stuckey, et al. Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction: The controlled abciximab and device investigation to lower late angioplasty complications (CADILLAC) trial J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1215 - 1223. [Abstract] [Full Text] [PDF]

				C. M. Gibson, L. K. Jennings, S. A. Murphy, D. P. Lorenz, R. P. Giugliano, R. A. Harrington, S. Cholera, R. Krishnan, R. M. Califf, E. Braunwald, et al. Association Between Platelet Receptor Occupancy After Eptifibatide (Integrilin) Therapy and Patency, Myocardial Perfusion, and ST-Segment Resolution Among Patients With ST-Segment-Elevation Myocardial Infarction: An INTEGRITI (Integrilin and Tenecteplase in Acute Myocardial Infarction) Substudy Circulation, August 10, 2004; 110(6): 679 - 684. [Abstract] [Full Text] [PDF]

				W J Desmet, L V Mesotten, A F Maes, H P Heidbuchel, L A Mortelmans, and F J Van de Werf Relation between different methods for analysing ST segment deviation and infarct size as assessed by positron emission tomography Heart, August 1, 2004; 90(8): 887 - 892. [Abstract] [Full Text] [PDF]

				M. T. Roe, C. L. Green, R. P. Giugliano, C. M. Gibson, K. Baran, M. Greenberg, S. T. Palmeri, S. Crater, K. Trollinger, K. Hannan, et al. Improved speed and stability of st-segment recovery with reduced-dose tenecteplase and eptifibatide compared with full-dose tenecteplase for acute st-segment elevation myocardial infarction J. Am. Coll. Cardiol., February 18, 2004; 43(4): 549 - 556. [Abstract] [Full Text] [PDF]

				E. Bjorklund, B. Lindahl, P. Johanson, T. Jernberg, A.-M. Svensson, P. Venge, L. Wallentin, M. Dellborg, and the ASSENT-2 and ASSENT-PLUS study groups Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction Eur. Heart J., January 2, 2004; 25(2): 113 - 120. [Abstract] [Full Text] [PDF]

				C. M. Gibson Has My Patient Achieved Adequate Myocardial Reperfusion? Circulation, August 5, 2003; 108(5): 504 - 507. [Full Text] [PDF]

				P. W. Armstrong, D. Collen, and E. Antman Fibrinolysis for Acute Myocardial Infarction: The Future Is Here and Now Circulation, May 27, 2003; 107(20): 2533 - 2537. [Full Text] [PDF]

				P. K. Haager, P. Christott, N. Heussen, W. Lepper, P. Hanrath, and R. Hoffmann Prediction of clinical outcome after mechanical revascularization in acute myocardial infarction by markers of myocardial reperfusion J. Am. Coll. Cardiol., February 19, 2003; 41(4): 532 - 538. [Abstract] [Full Text] [PDF]

				K Greaves, S R Dixon, M Fejka, W W O'Neill, S R Redwood, M S Marber, and R Senior Myocardial contrast echocardiography is superior to other known modalities for assessing myocardial reperfusion after acute myocardial infarction Heart, February 1, 2003; 89(2): 139 - 144. [Abstract] [Full Text] [PDF]

				J.P.S. Henriques, F. Zijlstra, J.P. Ottervanger, M.-J. de Boer, A.W.J. van 't Hof, J.C.A. Hoorntje, and H. Suryapranata Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction Eur. Heart J., July 2, 2002; 23(14): 1112 - 1117. [Abstract] [Full Text] [PDF]

				N. J. Goswami, J. M. Moody Jr, and S. R. Bailey Percutaneous Mechanical Reperfusion During Acute Myocardial Infarction J Intensive Care Med, July 1, 2002; 17(4): 162 - 173. [Abstract] [PDF]

				E.M. Antman, H.A. Cooper, C.M. Gibson, J.A. de Lemos, C.H. McCabe, R.P. Giugliano, P. Coussement, S. Murphy, J. Scherer, K. Anderson, et al. Determinants of improvement in epicardial flow and myocardial perfusion for ST elevation myocardial infarction. Insights from TIMI 14 and InTIME-II Eur. Heart J., June 2, 2002; 23(12): 928 - 933. [Abstract] [Full Text] [PDF]

				S. J. Brener, U. Zeymer, A. A. J. Adgey, T. R. Vrobel, S. G. Ellis, K.-L. Neuhaus, N. Juran, T. B. Ivanc, E. M. Ohman, J. Strony, et al. Eptifibatide and low-dose tissue plasminogen activator in acute myocardial infarction: The integrilin and low-dose thrombolysis in acute myocardial infarction (INTRO AMI) trial J. Am. Coll. Cardiol., February 6, 2002; 39(3): 377 - 386. [Abstract] [Full Text] [PDF]

				K. W. Baran, M. Nguyen, G. R. McKendall, C. T. Lambrew, G. Dykstra, S. T. Palmeri, R. J. Gibbons, S. Borzak, B. E. Sobel, S. G. Gourlay, et al. Double-Blind, Randomized Trial of an Anti-CD18 Antibody in Conjunction With Recombinant Tissue Plasminogen Activator for Acute Myocardial Infarction: Limitation of Myocardial Infarction Following Thrombolysis in Acute Myocardial Infarction (LIMIT AMI) Study Circulation, December 4, 2001; 104(23): 2778 - 2783. [Abstract] [Full Text] [PDF]

				C. M. Gibson Time Is Myocardium and Time Is Outcomes Circulation, November 27, 2001; 104(22): 2632 - 2634. [Full Text] [PDF]

				Y. Fu, S. Goodman, W.-C. Chang, F. Van de Werf, C. B. Granger, and P. W. Armstrong Time to Treatment Influences the Impact of ST-Segment Resolution on One-Year Prognosis: Insights From the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Trial Circulation, November 27, 2001; 104(22): 2653 - 2659. [Abstract] [Full Text] [PDF]

				J. A. de Lemos and E. Braunwald ST segment resolution as a tool for assessing the efficacy of reperfusion therapy J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1283 - 1294. [Abstract] [Full Text] [PDF]

				F. Zijlstra CORONARY DISEASE: Acute myocardial infarction: primary angioplasty Heart, June 1, 2001; 85(6): 705 - 709. [Full Text]

				R.G. Wilcox ST-segment elevation resolution -- a surrogate for infarct vessel patency or myocardial perfusion, but a call for rescue? Eur. Heart J., May 1, 2001; 22(9): 722 - 724. [PDF]

				U Zeymer, R Schroder, U Tebbe, G.P Molhoek, K Wegscheider, and K.-L Neuhaus Non-invasive detection of early infarct vessel patency by resolution of ST-segment elevation in patients with thrombolysis for acute myocardial infarction. Results of the angiographic substudy of the Hirudin for Improvement of Thrombolysis (HIT)-4 trial Eur. Heart J., May 1, 2001; 22(9): 769 - 775. [Abstract] [PDF]

				M. T. Roe, E. M. Ohman, A. C. P. Maas, R. H. Christenson, K. W. Mahaffey, C. B. Granger, R. A. Harrington, R. M. Califf, and M. W. Krucoff Shifting the open-artery hypothesis downstream: the quest for optimal reperfusion J. Am. Coll. Cardiol., January 1, 2001; 37(1): 9 - 18. [Abstract] [Full Text] [PDF]

				E. M. Ohman, R. A. Harrington, C. P. Cannon, G. Agnelli, J. A. Cairns, and J.W. Kennedy Intravenous Thrombolysis in Acute Myocardial Infarction Chest, January 1, 2001; 119(1_suppl): 253S - 277S. [Full Text] [PDF]

				E.M Antman, C.M Gibson, J.A de Lemos, R.P Giugliano, C.H McCabe, P Coussement, I Menown, C.A Nienaber, T.C Rehders, M.J Frey, et al. Combination reperfusion therapy with abciximab and reduced dose reteplase: results from TIMI 14 Eur. Heart J., December 1, 2000; 21(23): 1944 - 1953. [Abstract] [PDF]

				J. Andrews, I. T. Straznicky, J. K. French, C. L. Green, A. C. P. Maas, M. Lund, M. W. Krucoff, and H. D. White ST-Segment Recovery Adds to the Assessment of TIMI 2 and 3 Flow in Predicting Infarct Wall Motion After Thrombolytic Therapy Circulation, May 9, 2000; 101(18): 2138 - 2143. [Abstract] [Full Text] [PDF]

				C.P. Cannon Defining acute myocardial infarction by ST segment deviation Eur. Heart J., February 2, 2000; 21(4): 266 - 267. [PDF]

				S. Matetzky, M. Novikov, L. Gruberg, D. Freimark, M. Feinberg, D. Elian, I. Novikov, E. Di Segni, O. Agranat, Y. Har-Zahav, et al. The significance of persistent ST elevation versus early resolution of ST segment elevation after primary PTCA J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1932 - 1938. [Abstract] [Full Text] [PDF]

				R Schroder, U Zeymer, K Wegscheider, and K.L Neuhaus Comparison of the predictive value of ST segment elevation resolution at 90 and 180min after start of streptokinase in acute myocardial infarction. A substudy of the Hirudin for Improvement of Thrombolysis (HIT)-4 Study Eur. Heart J., November 1, 1999; 20(21): 1563 - 1571. [Abstract] [PDF]

				K.-L. Neuhaus, G. P. Molhoek, U. Zeymer, U. Tebbe, K. Wegscheider, R. Schroder, A. Camez, G. J. Laarman, G. M. Grollier, D. J. A. Lok, et al. Recombinant hirudin (lepirudin) for the improvement of thrombolysis with streptokinase in patients with acute myocardial infarction: Results of the HIT-4 trial J. Am. Coll. Cardiol., October 1, 1999; 34(4): 966 - 973. [Abstract] [Full Text] [PDF]

				P. Abrahamsson, K. Andersen, P. Eriksson, and M. Dellborg Prognostic value of maximum ST-vector magnitude during the first 24h of vectorcardiographic monitoring in patients with unstable angina pectoris Eur. Heart J., August 2, 1999; 20(16): 1166 - 1174. [Abstract] [PDF]

				I F Purcell, N Newall, and M Farrer Change in ST segment elevation 60 minutes after thrombolytic initiation predicts clinical outcome as accurately as later electrocardiographic changes Heart, November 1, 1997; 78(5): 465 - 471. [Abstract] [Full Text] [PDF]