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ST-Segment Resolution Predicts Mortality from Acute MI
Resolution of ST-segment elevation is a marker of functional myocardial recovery after recanalization of a coronary artery occlusion. These authors analyzed data from the industry-funded ASSENT-2 trial to determine the relation between ST-segment resolution 24 to 36 hours after fibrinolytic therapy and 1-year mortality.
Of 13,100 patients, 51.1% had complete resolution (
70% reduction in the initial sum of ST-segment elevation), 35.2% had partial resolution (30%-70% reduction), and 13.7% had no resolution. Women and smokers were more likely to have complete resolution. A history of diabetes, prior MI, prior coronary artery bypass graft, anterior MI at presentation, and congestive heart failure (CHF) at presentation were predictors of partial or no resolution. Shock, CHF, and recurrent ischemia occurred more often in patients with partial or no resolution. The amount of resolution decreased significantly as time to treatment increased: 55.6% of patients treated within 2 hours had complete resolution, compared with 52.1% of patients treated in 2 to 4 hours and 43% treated in 4 to 6 hours. Mortality at 1 year was 5.1%, 8.0%, and 9.7% for complete, partial, and no resolution, respectively (differences were significant).
Comment: This study shows that the extent of ST-segment recovery predicts mortality and that when resolution occurs, early time to treatment predicts further reductions in mortality. Time to treatment remains the single most important issue in MI management. Failure to resolve ST-segment elevation indicates a need for increased efforts to reperfuse the occluded coronary artery.
— James M. Christenson, MD, FRCPC
Published in Journal Watch Emergency Medicine January 30, 2002
Citation(s):
Fu Y et al. Time to treatment influences the impact of ST-segment resolution on one-year prognosis: Insights from the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Trial. Circulation 2001 Nov 27; 104:2653-9.
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