Grade 3 ischemia on admission electrocardiogram and chest pain duration predict failure of ST-segment resolution after primary percutaneous coronary intervention for acute myocardial infarction

Jarrett T. McGehee, Umamahesh Rangasetty, Shaul Atar, Nestor N. Barbagelata, Barry F. Uretsky, Yochai Birnbaum

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objectives: ST resolution (STR) is a surrogate marker of myocardial tissue reperfusion and a predictor of outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI). Terminal QRS distortion (grade 3 ischemia) has been shown to predict failure of STR after thrombolysis for STEMI, but the ability of grade 3 ischemia to predict STR with pPCI is unclear. Methods: We retrospectively analyzed 155 patients who underwent pPCI and compared grade 2 ischemia (ST elevation without terminal QRS distortion; n = 89) to grade 3 ischemia (n = 66) on admission for baseline characteristics, in-hospital course, and STR immediately after pPCI and at 18 to 24 hours. Results: Patients with grade 3 ischemia were older (60 ± 12 vs 56 ± 11 years; P = .018), had more anterior STEMI (42% vs 17%; P = .0004), and were less often smokers (41% vs 90%; P = .004). The grade 3 ischemic group had significantly less complete STR (35% vs 75% [P < .00001] immediately after pPCI and 33% vs 79% [P < .00001] 18-24 hours after pPCI), a longer hospital stay (6.4 ± 4.1 vs 4.9 ± 1.9 days; P = .008), and higher peak CKMB (292 ± 231 vs 195 ± 176 ng/mL; P = .0005). Duration of symptoms before pPCI (odds ratio [OR], 0.838; 95% confidence interval [CI], 0.724-0.969; P = .017) and grade 3 ischemia (OR, 0.181; 95% CI, 0.068-0.480; P < .001) were negative predictors of complete STR, whereas nonanterior STEMI (OR, 5.95; 95% CI, 2.154-16.436; P < .001) and initial sum of ST elevation (OR, 3.132; 95% CI, 1.140-8.605; P = .027) were positive predictors. Conclusion: Grade 3 ischemia on presentation of STEMI and duration of chest pain are strong independent predictors of failure to achieve complete STR after pPCI.

Original languageEnglish (US)
Pages (from-to)26-33
Number of pages8
JournalJournal of Electrocardiology
Volume40
Issue number1
DOIs
StatePublished - Jan 2007

Fingerprint

Percutaneous Coronary Intervention
Chest Pain
Electrocardiography
Ischemia
Myocardial Infarction
Odds Ratio
Confidence Intervals
Myocardial Reperfusion
Length of Stay
Biomarkers
ST Elevation Myocardial Infarction

Keywords

  • Grades of ischemia
  • Primary angioplasty
  • ST elevation
  • ST resolution

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Grade 3 ischemia on admission electrocardiogram and chest pain duration predict failure of ST-segment resolution after primary percutaneous coronary intervention for acute myocardial infarction. / McGehee, Jarrett T.; Rangasetty, Umamahesh; Atar, Shaul; Barbagelata, Nestor N.; Uretsky, Barry F.; Birnbaum, Yochai.

In: Journal of Electrocardiology, Vol. 40, No. 1, 01.2007, p. 26-33.

Research output: Contribution to journalArticle

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abstract = "Objectives: ST resolution (STR) is a surrogate marker of myocardial tissue reperfusion and a predictor of outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI). Terminal QRS distortion (grade 3 ischemia) has been shown to predict failure of STR after thrombolysis for STEMI, but the ability of grade 3 ischemia to predict STR with pPCI is unclear. Methods: We retrospectively analyzed 155 patients who underwent pPCI and compared grade 2 ischemia (ST elevation without terminal QRS distortion; n = 89) to grade 3 ischemia (n = 66) on admission for baseline characteristics, in-hospital course, and STR immediately after pPCI and at 18 to 24 hours. Results: Patients with grade 3 ischemia were older (60 ± 12 vs 56 ± 11 years; P = .018), had more anterior STEMI (42{\%} vs 17{\%}; P = .0004), and were less often smokers (41{\%} vs 90{\%}; P = .004). The grade 3 ischemic group had significantly less complete STR (35{\%} vs 75{\%} [P < .00001] immediately after pPCI and 33{\%} vs 79{\%} [P < .00001] 18-24 hours after pPCI), a longer hospital stay (6.4 ± 4.1 vs 4.9 ± 1.9 days; P = .008), and higher peak CKMB (292 ± 231 vs 195 ± 176 ng/mL; P = .0005). Duration of symptoms before pPCI (odds ratio [OR], 0.838; 95{\%} confidence interval [CI], 0.724-0.969; P = .017) and grade 3 ischemia (OR, 0.181; 95{\%} CI, 0.068-0.480; P < .001) were negative predictors of complete STR, whereas nonanterior STEMI (OR, 5.95; 95{\%} CI, 2.154-16.436; P < .001) and initial sum of ST elevation (OR, 3.132; 95{\%} CI, 1.140-8.605; P = .027) were positive predictors. Conclusion: Grade 3 ischemia on presentation of STEMI and duration of chest pain are strong independent predictors of failure to achieve complete STR after pPCI.",
keywords = "Grades of ischemia, Primary angioplasty, ST elevation, ST resolution",
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T1 - Grade 3 ischemia on admission electrocardiogram and chest pain duration predict failure of ST-segment resolution after primary percutaneous coronary intervention for acute myocardial infarction

AU - McGehee, Jarrett T.

AU - Rangasetty, Umamahesh

AU - Atar, Shaul

AU - Barbagelata, Nestor N.

AU - Uretsky, Barry F.

AU - Birnbaum, Yochai

PY - 2007/1

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N2 - Objectives: ST resolution (STR) is a surrogate marker of myocardial tissue reperfusion and a predictor of outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI). Terminal QRS distortion (grade 3 ischemia) has been shown to predict failure of STR after thrombolysis for STEMI, but the ability of grade 3 ischemia to predict STR with pPCI is unclear. Methods: We retrospectively analyzed 155 patients who underwent pPCI and compared grade 2 ischemia (ST elevation without terminal QRS distortion; n = 89) to grade 3 ischemia (n = 66) on admission for baseline characteristics, in-hospital course, and STR immediately after pPCI and at 18 to 24 hours. Results: Patients with grade 3 ischemia were older (60 ± 12 vs 56 ± 11 years; P = .018), had more anterior STEMI (42% vs 17%; P = .0004), and were less often smokers (41% vs 90%; P = .004). The grade 3 ischemic group had significantly less complete STR (35% vs 75% [P < .00001] immediately after pPCI and 33% vs 79% [P < .00001] 18-24 hours after pPCI), a longer hospital stay (6.4 ± 4.1 vs 4.9 ± 1.9 days; P = .008), and higher peak CKMB (292 ± 231 vs 195 ± 176 ng/mL; P = .0005). Duration of symptoms before pPCI (odds ratio [OR], 0.838; 95% confidence interval [CI], 0.724-0.969; P = .017) and grade 3 ischemia (OR, 0.181; 95% CI, 0.068-0.480; P < .001) were negative predictors of complete STR, whereas nonanterior STEMI (OR, 5.95; 95% CI, 2.154-16.436; P < .001) and initial sum of ST elevation (OR, 3.132; 95% CI, 1.140-8.605; P = .027) were positive predictors. Conclusion: Grade 3 ischemia on presentation of STEMI and duration of chest pain are strong independent predictors of failure to achieve complete STR after pPCI.

AB - Objectives: ST resolution (STR) is a surrogate marker of myocardial tissue reperfusion and a predictor of outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI). Terminal QRS distortion (grade 3 ischemia) has been shown to predict failure of STR after thrombolysis for STEMI, but the ability of grade 3 ischemia to predict STR with pPCI is unclear. Methods: We retrospectively analyzed 155 patients who underwent pPCI and compared grade 2 ischemia (ST elevation without terminal QRS distortion; n = 89) to grade 3 ischemia (n = 66) on admission for baseline characteristics, in-hospital course, and STR immediately after pPCI and at 18 to 24 hours. Results: Patients with grade 3 ischemia were older (60 ± 12 vs 56 ± 11 years; P = .018), had more anterior STEMI (42% vs 17%; P = .0004), and were less often smokers (41% vs 90%; P = .004). The grade 3 ischemic group had significantly less complete STR (35% vs 75% [P < .00001] immediately after pPCI and 33% vs 79% [P < .00001] 18-24 hours after pPCI), a longer hospital stay (6.4 ± 4.1 vs 4.9 ± 1.9 days; P = .008), and higher peak CKMB (292 ± 231 vs 195 ± 176 ng/mL; P = .0005). Duration of symptoms before pPCI (odds ratio [OR], 0.838; 95% confidence interval [CI], 0.724-0.969; P = .017) and grade 3 ischemia (OR, 0.181; 95% CI, 0.068-0.480; P < .001) were negative predictors of complete STR, whereas nonanterior STEMI (OR, 5.95; 95% CI, 2.154-16.436; P < .001) and initial sum of ST elevation (OR, 3.132; 95% CI, 1.140-8.605; P = .027) were positive predictors. Conclusion: Grade 3 ischemia on presentation of STEMI and duration of chest pain are strong independent predictors of failure to achieve complete STR after pPCI.

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