ST-Segment Recovery and Outcome After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Insights From the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) Trial
Background— Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining prognosis after primary percutaneous coronary intervention (PCI) would facilitate appropriate care and expedite hospital discharge. Thus,...
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| Published in | Circulation (New York, N.Y.) Vol. 118; no. 13; pp. 1335 - 1346 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
Lippincott Williams & Wilkins
23.09.2008
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-7322 1524-4539 1524-4539 |
| DOI | 10.1161/CIRCULATIONAHA.108.767772 |
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| Abstract | Background—
Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining prognosis after primary percutaneous coronary intervention (PCI) would facilitate appropriate care and expedite hospital discharge. Thus, we determined the prognostic importance of various measures of ST-segment–elevation recovery after primary PCI in a large, contemporary cohort of patients with ST-elevation myocardial infarction.
Methods and Results—
We analyzed ECG data describing the magnitude and extent of ST-segment elevation and deviation before and early after (ie, 30 minutes) primary PCI in the study cohort of 4866 subjects with electrocardiographically high-risk ST-elevation myocardial infarction enrolled in the Assessment of PEXelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Associations among 6 methods for calculating ST-segment recovery, biomarker estimates of infarct size (ie, peak creatine kinase, creatine kinase-MB, and troponin I and T), and prespecified clinical outcomes (ie, rates of 90-day death and 90-day death, heart failure, or shock) were examined. All ST-segment–recovery methods provided strong prognostic information regarding clinical outcomes. A simple ST-segment–recovery method of residual ST-segment elevation measurement in the most affected lead on the post-PCI ECG performed as well as complex methods that required comparison of pre- and post-PCI ECGs or calculation of summed ST-segment deviation in multiple leads (ie, worst-lead residual ST elevation: adjusted hazard ratio for 90-day death rate [reference <1 mm]: 1 to <2 mm, 1.23 [95% CI 0.74 to 2.03]; ≥2 mm, 2.22 [95% CI 1.35 to 3.65], corrected c-index=0.832; 90-day death/congestive heart failure/shock [reference <1 mm]: 1 to <2 mm, 1.55 [95% CI 1.06 to 2.26]; ≥2 mm, 2.33 [95% CI 1.59 to 3.41], corrected c-index=0.802). Biomarker estimates of infarct size declined in association with enhanced ST-segment recovery.
Conclusions—
An ECG performed early after primary PCI is a simple, widely available, inexpensive, and powerful prognostic tool applicable to patients with ST-elevation myocardial infarction. |
|---|---|
| AbstractList | Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining prognosis after primary percutaneous coronary intervention (PCI) would facilitate appropriate care and expedite hospital discharge. Thus, we determined the prognostic importance of various measures of ST-segment-elevation recovery after primary PCI in a large, contemporary cohort of patients with ST-elevation myocardial infarction.
We analyzed ECG data describing the magnitude and extent of ST-segment elevation and deviation before and early after (ie, 30 minutes) primary PCI in the study cohort of 4866 subjects with electrocardiographically high-risk ST-elevation myocardial infarction enrolled in the Assessment of PEXelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Associations among 6 methods for calculating ST-segment recovery, biomarker estimates of infarct size (ie, peak creatine kinase, creatine kinase-MB, and troponin I and T), and prespecified clinical outcomes (ie, rates of 90-day death and 90-day death, heart failure, or shock) were examined. All ST-segment-recovery methods provided strong prognostic information regarding clinical outcomes. A simple ST-segment-recovery method of residual ST-segment elevation measurement in the most affected lead on the post-PCI ECG performed as well as complex methods that required comparison of pre- and post-PCI ECGs or calculation of summed ST-segment deviation in multiple leads (ie, worst-lead residual ST elevation: adjusted hazard ratio for 90-day death rate [reference <1 mm]: 1 to <2 mm, 1.23 [95% CI 0.74 to 2.03]; > or =2 mm, 2.22 [95% CI 1.35 to 3.65], corrected c-index=0.832; 90-day death/congestive heart failure/shock [reference <1 mm]: 1 to <2 mm, 1.55 [95% CI 1.06 to 2.26]; > or =2 mm, 2.33 [95% CI 1.59 to 3.41], corrected c-index=0.802). Biomarker estimates of infarct size declined in association with enhanced ST-segment recovery.
An ECG performed early after primary PCI is a simple, widely available, inexpensive, and powerful prognostic tool applicable to patients with ST-elevation myocardial infarction. Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining prognosis after primary percutaneous coronary intervention (PCI) would facilitate appropriate care and expedite hospital discharge. Thus, we determined the prognostic importance of various measures of ST-segment-elevation recovery after primary PCI in a large, contemporary cohort of patients with ST-elevation myocardial infarction.BACKGROUNDPrimary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining prognosis after primary percutaneous coronary intervention (PCI) would facilitate appropriate care and expedite hospital discharge. Thus, we determined the prognostic importance of various measures of ST-segment-elevation recovery after primary PCI in a large, contemporary cohort of patients with ST-elevation myocardial infarction.We analyzed ECG data describing the magnitude and extent of ST-segment elevation and deviation before and early after (ie, 30 minutes) primary PCI in the study cohort of 4866 subjects with electrocardiographically high-risk ST-elevation myocardial infarction enrolled in the Assessment of PEXelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Associations among 6 methods for calculating ST-segment recovery, biomarker estimates of infarct size (ie, peak creatine kinase, creatine kinase-MB, and troponin I and T), and prespecified clinical outcomes (ie, rates of 90-day death and 90-day death, heart failure, or shock) were examined. All ST-segment-recovery methods provided strong prognostic information regarding clinical outcomes. A simple ST-segment-recovery method of residual ST-segment elevation measurement in the most affected lead on the post-PCI ECG performed as well as complex methods that required comparison of pre- and post-PCI ECGs or calculation of summed ST-segment deviation in multiple leads (ie, worst-lead residual ST elevation: adjusted hazard ratio for 90-day death rate [reference <1 mm]: 1 to <2 mm, 1.23 [95% CI 0.74 to 2.03]; > or =2 mm, 2.22 [95% CI 1.35 to 3.65], corrected c-index=0.832; 90-day death/congestive heart failure/shock [reference <1 mm]: 1 to <2 mm, 1.55 [95% CI 1.06 to 2.26]; > or =2 mm, 2.33 [95% CI 1.59 to 3.41], corrected c-index=0.802). Biomarker estimates of infarct size declined in association with enhanced ST-segment recovery.METHODS AND RESULTSWe analyzed ECG data describing the magnitude and extent of ST-segment elevation and deviation before and early after (ie, 30 minutes) primary PCI in the study cohort of 4866 subjects with electrocardiographically high-risk ST-elevation myocardial infarction enrolled in the Assessment of PEXelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Associations among 6 methods for calculating ST-segment recovery, biomarker estimates of infarct size (ie, peak creatine kinase, creatine kinase-MB, and troponin I and T), and prespecified clinical outcomes (ie, rates of 90-day death and 90-day death, heart failure, or shock) were examined. All ST-segment-recovery methods provided strong prognostic information regarding clinical outcomes. A simple ST-segment-recovery method of residual ST-segment elevation measurement in the most affected lead on the post-PCI ECG performed as well as complex methods that required comparison of pre- and post-PCI ECGs or calculation of summed ST-segment deviation in multiple leads (ie, worst-lead residual ST elevation: adjusted hazard ratio for 90-day death rate [reference <1 mm]: 1 to <2 mm, 1.23 [95% CI 0.74 to 2.03]; > or =2 mm, 2.22 [95% CI 1.35 to 3.65], corrected c-index=0.832; 90-day death/congestive heart failure/shock [reference <1 mm]: 1 to <2 mm, 1.55 [95% CI 1.06 to 2.26]; > or =2 mm, 2.33 [95% CI 1.59 to 3.41], corrected c-index=0.802). Biomarker estimates of infarct size declined in association with enhanced ST-segment recovery.An ECG performed early after primary PCI is a simple, widely available, inexpensive, and powerful prognostic tool applicable to patients with ST-elevation myocardial infarction.CONCLUSIONSAn ECG performed early after primary PCI is a simple, widely available, inexpensive, and powerful prognostic tool applicable to patients with ST-elevation myocardial infarction. Background— Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining prognosis after primary percutaneous coronary intervention (PCI) would facilitate appropriate care and expedite hospital discharge. Thus, we determined the prognostic importance of various measures of ST-segment–elevation recovery after primary PCI in a large, contemporary cohort of patients with ST-elevation myocardial infarction. Methods and Results— We analyzed ECG data describing the magnitude and extent of ST-segment elevation and deviation before and early after (ie, 30 minutes) primary PCI in the study cohort of 4866 subjects with electrocardiographically high-risk ST-elevation myocardial infarction enrolled in the Assessment of PEXelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Associations among 6 methods for calculating ST-segment recovery, biomarker estimates of infarct size (ie, peak creatine kinase, creatine kinase-MB, and troponin I and T), and prespecified clinical outcomes (ie, rates of 90-day death and 90-day death, heart failure, or shock) were examined. All ST-segment–recovery methods provided strong prognostic information regarding clinical outcomes. A simple ST-segment–recovery method of residual ST-segment elevation measurement in the most affected lead on the post-PCI ECG performed as well as complex methods that required comparison of pre- and post-PCI ECGs or calculation of summed ST-segment deviation in multiple leads (ie, worst-lead residual ST elevation: adjusted hazard ratio for 90-day death rate [reference <1 mm]: 1 to <2 mm, 1.23 [95% CI 0.74 to 2.03]; ≥2 mm, 2.22 [95% CI 1.35 to 3.65], corrected c-index=0.832; 90-day death/congestive heart failure/shock [reference <1 mm]: 1 to <2 mm, 1.55 [95% CI 1.06 to 2.26]; ≥2 mm, 2.33 [95% CI 1.59 to 3.41], corrected c-index=0.802). Biomarker estimates of infarct size declined in association with enhanced ST-segment recovery. Conclusions— An ECG performed early after primary PCI is a simple, widely available, inexpensive, and powerful prognostic tool applicable to patients with ST-elevation myocardial infarction. |
| Author | Granger, Christopher B. Westerhout, Cynthia M. Van de Werf, Frans J. Wagner, Galen S. Buller, Christopher E. White, Harvey D. Adams, Peter Armstrong, Paul W. Mahaffey, Kenneth W. Fu, Yuling Todaro, Thomas G. van 't Hof, Arnoud W.J. |
| Author_xml | – sequence: 1 givenname: Christopher E. surname: Buller fullname: Buller, Christopher E. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 2 givenname: Yuling surname: Fu fullname: Fu, Yuling organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 3 givenname: Kenneth W. surname: Mahaffey fullname: Mahaffey, Kenneth W. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 4 givenname: Thomas G. surname: Todaro fullname: Todaro, Thomas G. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 5 givenname: Peter surname: Adams fullname: Adams, Peter organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 6 givenname: Cynthia M. surname: Westerhout fullname: Westerhout, Cynthia M. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 7 givenname: Harvey D. surname: White fullname: White, Harvey D. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 8 givenname: Arnoud W.J. surname: van 't Hof fullname: van 't Hof, Arnoud W.J. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 9 givenname: Frans J. surname: Van de Werf fullname: Van de Werf, Frans J. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 10 givenname: Galen S. surname: Wagner fullname: Wagner, Galen S. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 11 givenname: Christopher B. surname: Granger fullname: Granger, Christopher B. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital – sequence: 12 givenname: Paul W. surname: Armstrong fullname: Armstrong, Paul W. organization: From Vancouver General Hospital (C.E.B.), University of British Columbia, Vancouver, British Columbia, Canada; University of Alberta (Y.F., C.M.W., P.W.A.), Edmonton, Alberta, Canada; Duke Clinical Research Institute (K.W.M., G.S.W., C.B.G.), Durham, NC; Procter & Gamble (T.G.T.), Cincinnati, Ohio; Alexion Pharmaceuticals (P.A.), Cheshire, Conn; Green Lane Cardiovascular Research Unit (H.D.W.), Auckland, New Zealand; Isala Klinieken (A.W.J.v.H.), Zwolle, Netherlands; and University Hospital |
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| Keywords | Myocardial infarction Prognosis ST interval infarction Cardiovascular disease Instrumental dilatation Pexelizumab Myocardial disease Coronary heart disease Percutaneous route Immunomodulator ST elevation Electrocardiography Apex angioplasty |
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Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of... Primary percutaneous coronary angioplasty is an effective and widely adopted treatment for acute myocardial infarction. A simple method of determining... |
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| SubjectTerms | Aged Angioplasty, Balloon, Coronary - mortality Antibodies, Monoclonal - administration & dosage Antibodies, Monoclonal, Humanized Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cohort Studies Combined Modality Therapy Coronary heart disease Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Female Heart Heart Failure - mortality Humans Kaplan-Meier Estimate Male Medical sciences Middle Aged Multivariate Analysis Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocardial Infarction - therapy Predictive Value of Tests Prognosis Recovery of Function Shock, Cardiogenic - mortality Single-Chain Antibodies Treatment Outcome |
| Subtitle | Insights From the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) Trial |
| Title | ST-Segment Recovery and Outcome After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction |
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