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ACUTE MYOCARDIAL INFARCTION

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

Michael G. McLaughlin, MD^*, Gregg W. Stone, MD, FACC, Eve Aymong, MD, MS, Graham Gardner, MD^*, Roxana Mehran, MD, FACC, Alexandra J. Lansky, MD, FACC, Cindy L. Grines, MD, FACC, James E. Tcheng, MD, FACC, David A. Cox, MD, FACC^||, Thomas Stuckey, MD, FACC^¶, Eulogio Garcia, MD^#, Giulio Guagliumi, MD^**, Mark Turco, MD, FACC, Mark E. Josephson, MD, FACC^* and Peter Zimetbaum, MD, FACC^*,*

^* Beth Israel Deaconess Medical Center, Boston, Massachusetts
Cardiovascular Research Foundation and Lenox Hill Heart and Vascular Institute, New York, New York, USA
William Beaumont Hospital, Royal Oak, Michigan, USA
Duke Clinical Research Institute, Durham, North Carolina, USA
^|| Mid Carolina Cardiology, Charlotte, North Carolina, USA
^¶ Moses Cone Memorial Hospital, Greensboro, North Carolina, USA
^# Hospital Gregorio Maranon, Madrid, Spain
^** Ospedali Riuniti di Bergamo, Bergamo, Italy
Doylestown Hospital, Doylestown, Pennsylvania, USA

Manuscript received April 22, 2004; revised manuscript received June 9, 2004, accepted June 14, 2004.

^* Reprint requests and correspondence: Dr. Peter Zimetbaum, Beth Israel Deaconess Medical Center, One Deaconess Road, Baker 4, Boston, Massachusetts 02215 (Email: pzimetba{at}bidmc.harvard.edu).

OBJECTIVE: This study was done to assess and compare the prognostic significance of multiple methods for measuringST-segment elevation resolution (STR) following primary percutaneous coronary intervention (PCI).

BACKGROUND: Resolution of ST-segment elevation (STE) is a powerful predictor of both infarct-related artery patency and mortality in acute myocardial infarction (AMI). Recent thrombolytic studies have suggested that simple measures of STR may be as powerful as more complex algorithms. The optimal method of assessing STR following primary PCI has not been studied.

METHODS: We analyzed 700 patients with technically adequate baseline and post-PCI electrocardiograms from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Five methods were used to assess STR: 1) summed %STR across multiple leads (STR); 2) %STR in the single lead with maximum baseline STE (MaxSTR); 3) absolute maximum STE before the procedure; 4) absolute maximum STE after intervention (MaxSTPost); and 5) a categorical variable based upon MaxSTPost (High Risk).

RESULTS: At 30 days, STR, MaxSTR, and MaxSTPost all correlated strongly with mortality (p = 0.004, p = 0.005, and p < 0.0001, respectively) and the combined end point of mortality or reinfarction (p = 0.001, p = 0.001, and p < 0.0001). At one year, STR and MaxSTPost correlated with mortality (p = 0.04, p = 0.0001), reinfarction (p = 0.02, p = 0.0015), and the combined end point (p = 0.02, p < 0.0001). By multivariate analysis, only the simpler measures of MaxSTPost and High Risk categorization independently predicted all outcomes at both time points.

CONCLUSIONS: The STR following primary PCI in AMI correlates strongly with mortality and reinfarction, independent of target vessel patency. The simple measure of the maximal residual degree of STE after primary PCI is a strong independent predictor of both survival and freedom from reinfarction at 30 days and 1 year.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CADILLAC = Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications   ECG = electrocardiogram   LBBB = left-bundle branch block   MI = myocardial infarction   MSTD = minimal ST-segment deviation   PCI = percutaneous coronary intervention   STE = ST-segment elevation   STR = ST-segment elevation resolution   TIMI = Thrombolysis In Myocardial Infarction

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