Correlation between post-PTCA Correlation between post-PTCA resolution of ST segment and resolution of ST segment and

mortality in STEMI patientsmortality in STEMI patients

First author: Diana Opincariu

Co-authors: Carmen Moldovan Daniel Balan

Coordinators: Prof. Dr. Benedek Imre

Prof. Dr. Benedek Theodora

University of Medicine and Pharmacy Tg. MuresCardiology Clinic, Mures Emergency Clinical County Hospital

BackgroundBackground

The acute myocardial infarction causes changes in the electrical activity of the heart.

BackgroundBackgroundThe extent of the necrosis can be decreased through

Decrease in ST segment elevation

Thrombolysis PTCA

ObjectiveObjective

The present study aims to identify a

correlation between mortality in STEMI

patients and ST segment resolution

following revascularization

(PTCA)

Materials and methodsMaterials and methods

Inclusion criteriaInclusion criteria

• Acute myocardial infarction with ST segment elevation

• Primary PCI (TIMI flow 2-3) within the first 12 h after onset of symptoms

ExclusionExclusion criteriacriteria

• Left bundle branch block occured after the AMI

• History of heart surgery

• Age under 18

298 patients298 patients

Materials and methodsMaterials and methodsISSTE = integrated score of ST elevation

ISSTE was calculated by summing the amplitudes of the ST segment elevations in all the leads (12 lead ECG)

Materials and methodsMaterials and methods

ISSTE = integrated score of ST elevation

The pre and post-revascularization (1-2 days after) ISSTE were calculated and compared.

An efficient revascularization was defined as a decrease in the ISSTE score by >=50%

The analysis of the data was performed by using MS Excel, GraphPad InStat and Fisher’s exact statistical test

ResultsResults

• The study population was divided into 2 groups

Group 1

259 patients with >=50% decrease in the ISSTE

Group 2

39 patients with a decrease in the ISSTE of <50%

Characteristics of the study Characteristics of the study populationpopulation

AGEAGE

GENDERGENDER

0

50

100

150

200

1 2

groups

male

female

NSNS

NSNS

NSNS

NSNS

NSNS

NSNS

NSNS

NSNS

Infarct related Infarct related arteryartery

Group 1

45%

41%

14%

LAD

RCA

CxA

Group 2

49%

38%

13%

LAD

RCA

CxA

RCA – right coronary artery, LAD – left anterior descendant; CxA– circumflex artery

NSNS

Infarct related Infarct related arteryartery

RCA – right coronary artery, LAD – left anterior descendant; CxA– circumflex artery

NSNS

LAD

86%

14%

1

2

RCA

88%

12%

1

2

CxA

88%

12%

1

2

ResultsResults

Group 1 = >=50% decrease in ISSTE Group 2 = decrease in ISSTE of <50%

Group 1 Group 2 Total

Number of cases 259 39 298

Survivors 242 29 271

Deceased 17 10 27

Mortality 6.56% 25.64%

p=0.00086,56

25,64

0,00

10,00

20,00

30,00

1 2

Mortality %

Group 1 Group 2

Survivors

Deceased

93.44%

6.56%73.36%

25.64%

ConclusionsConclusions

• The study demonstrates the correlation between ST segment amplitude decrease, post-PTCA, and mortality in STEMI patients

• ISSTE is a new prognostic marker associated with post-myocardial infarction mortality

• A >50% decrease in the ISSTE score following revascularization is associated with a decrease in mortality in STEMI patients.

Special recognition to members of Cardiology

Clinic, of the MURES COUNTY EMERGENCY CLINICAL HOSPITAL- Prof. Dr.

Benedek Imre Prof. Dr. Benedek Theodora

Thank youThank you for yourfor your

attentionattention