What is the best ST-segment recovery parameter to predict clinical outcome and myocardial infarct size? Amplitude, speed, and completeness of ST-segment recovery after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
AIMS
ST-segment recovery (STR) is a strong mechanistic correlate of infarct size (IS) and outcome in ST-segment elevation myocardial infarction (STEMI). Characterizing measures of speed, amplitude, and completeness of STR may extend the use of this noninvasive biomarker.


METHODS AND RESULTS
Core laboratory continuous 24-h 12-lead Holter ECG monitoring, IS by single-photon emission computed tomography (SPECT), and 30-day mortality of 2 clinical trials of primary percutaneous coronary intervention in STEMI were combined. Multiple ST measures (STR at last contrast injection (LC) measured from peak value; 30, 60, 90, 120, and 240min, residual deviation; time to steady ST recovery; and the 3-h area under the time trend curve [ST-AUC] from LC) were univariably correlated with IS and predictive of mortality. After multivariable adjustment for ST-parameters and GRACE risk factors, STR at 240min remained an additive predictor of mortality. Early STR, residual deviation, and ST-AUC remained associated with IS.


CONCLUSIONS
Multiple parameters that quantify the speed, amplitude, and completeness of STR predict mortality and correlate with IS.
['Kuijt|Wichert J|WJ|', 'Green|Cindy L|CL|', 'Verouden|Niels J W|NJW|', 'Haeck|Joost D E|JDE|', 'Tzivoni|Dan|D|', 'Koch|Karel T|KT|', 'Stone|Gregg W|GW|', 'Lansky|Alexandra J|AJ|', 'Broderick|Samuel|S|', 'Tijssen|Jan G P|JGP|', 'de Winter|Robbert J|RJ|', 'Roe|Matthew T|MT|', 'Krucoff|Mitchell W|MW|']
D003287:Contrast Media D015716:Electrocardiography, Ambulatory D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D062645:Percutaneous Coronary Intervention D011237:Predictive Value of Tests D012307:Risk Factors D000072657:ST Elevation Myocardial Infarction D015899:Tomography, Emission-Computed, Single-Photon D016896:Treatment Outcome
Myocardial infarct size Primary percutaneous coronary intervention ST-segment elevation myocardial infarction Continuous ST-segment recovery Prognosis