Please use this identifier to cite or link to this item: https://repositorio.unifesp.br/handle/11600/56167
Title: Implications of ischaemic area at risk and mode of reperfusion in ST-elevation myocardial infarction
Authors: Bainey, Kevin R.
Fresco, Claudio
Zheng, Yinggan
Halvorsen, Sigrun
Carvalho, Antonio [UNIFESP]
Ostojic, Miodrag
Goldstein, Patrick
Gershlick, Anthony H.
Westerhout, Cynthia M.
Van de Werf, Frans
Armstrong, Paul W.
Issue Date: 2016
Publisher: Bmj Publishing Group
Citation: Heart. London, v. 102, n. 7, p. 527-533, 2016.
Abstract: Objective Uncertainty exists concerning the relative merits of pharmacological versus mechanical coronary reperfusion in patients presenting early with ST-elevation myocardial infarction (STEMI) with extensive myocardium at risk. Accordingly, we investigated whether the extent of baseline ST-segment shift was related to the response of either reperfusion modality in patients with STEMI presenting within 3 h of symptoms. Methods We analysed baseline ECGs from 1859 patients enrolled in the STrategic Reperfusion Early After Myocardial Infarction (STREAM) trial. The sum of ST-segment elevation (Sigma STE) and ST-segment deviation (Sigma STD) was categorised into quartiles and associations with the primary endpoint (30-day death/shock/ congestive heart failure/re-myocardial infarction) for each reperfusion strategy (early fibrinolysis vs primary percutaneous coronary intervention) were explored. Results Overall, there was a progressive rise in the 30-day primary endpoint according to quartiles of baseline Sigma STE (10.3% (0-5 mm), 12.4% (5.5-8.5 mm), 12.1% (9-13.5 mm), 17.6% (>14.0 mm), p=0.008) and Sigma STD (9.0% (0-9 mm), 13.5% (9.5-14 mm), 14.7% (14.520 mm), 15.3% (>20 mm), p=0.019). Both Sigma STE and Sigma STD were associated with the primary endpoint (Sigma STE: p=0.071
Sigma STD: p=0.024). However, there was no interaction between quartiles of baseline Sigma STE or Sigma STD and efficacy of either reperfusion strategy on the 30-day clinical outcomes (Sigma STE: p (interaction)=0.696
Sigma STD: p (interaction)=0.542). Conclusions These data demonstrate an association between Sigma STE or Sigma STD on the baseline ECG and clinical events at 30 days following reperfusion therapy in STEMI. More importantly, the response to different reperfusion strategies was not influenced by the extent of jeopardised myocardium.
URI: https://repositorio.unifesp.br/handle/11600/56167
ISSN: 1355-6037
Other Identifiers: http://dx.doi.org/10.1136/heartjnl-2015-308075
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