K.M. Amosova, Yu.O. Sychenko, Iu.V. Rudenko, I.V. Prudkyi, A.B. Bezrodnyi, I.Yu. Katsytadze, I.I. Gorda. ST-segment resolution after primary percutaneous coronary intervention: incidence, clinical significance and independent predictors

The aim – to determine the frequency of ST-segment resolution after primary percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), its impact on the nearest outcome and possible predictors.

Material and methods. We performed retrospective analysis of case reports of 162 patients with ACS with ST-segment elevation without cardiogenic shock at admission, who underwent PCI. We analyzed the dynamics of the ST-segment in 30 minutes after opening the occluded coronary artery. Patients were divided into groups depending on presence or absence of resolution ST ≥ 70 % after 30 minutes.

Results. The first group was significantly older (P<0.05), with predomination of women, higher frequency of previous MI, diabetes, AHF Killip II–III at admission (all Р<0.05). In ST < 70 % group there was higher frequency of the anterior MI localization – 76.4 % and in the group with the resolution ST ≥ 70 inferior MI prevailed (82.1 %) (Р<0.001). After PCI in the second group the max STE1 was significantly lower – 0.09±0.07 mm, compared to 0.23±0.04 in the first group. In the group without resolution of ST (< 70 %) the majority (57.5 %) were patients with lesions of the anterior interventricular branch of the left coronary artery, in the group with resolution of ST – patients with lesions of the right coronary artery (RKA) (69.6 %) (Р<0.001). Patients with resolution ST ≥ 70 % achieved recovery of coronary artery blood flow in 94.6 % and in the group without resolution ST < 70 %, ТІМІ 3 flow was achieved only in 59.4 %. The resolution of ST ≥ 70 %, compared with smaller resolution, was associated with lower hospital mortality (0 vs 8.5 %), lower frequency of AHF Killip II–III (8.9 vs.21.7 %), and the combined end point – death + nonfatal re-infarction + angina postinfarction + nonfatal VF/VT (16.1 vs. 29.2 %) against and death + nonfatal re-infarction (5.4 vs. 15.1 %) of all Р<0.05. Conclusions. In real clinical practice patients with ST-elevation ACS, hospitalized at 5.8 hours average and receiving PCI, resolution ST ≥ 70 % happened in 34.6 % and was associated with reduced hospital mortality, AHF and total serious cardiovascular events during hospital period. Patients with ST resolution ≥ 70 % had shorter time of ischemia, lower AHF Killip class, lower TIMI risk score, were younger, with predominance of the inferior and/or lateral location of MI, were more likely to restore TIMI 3 grade blood flow.

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