Abstract
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. We analysed baseline ECGs from 1859 patients enrolled in the STrategic Reperfusion Early After Myocardial Infarction (STREAM) trial. The sum of ST-segment elevation (∑STE) and ST-segment deviation (∑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. Overall, there was a progressive rise in the 30-day primary endpoint according to quartiles of baseline ∑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 ∑STD (9.0% (0-9 mm), 13.5% (9.5-14 mm), 14.7% (14.5-20 mm), 15.3% (> 20 mm), p = 0.019). Both ∑STE and ∑STD were associated with the primary endpoint (∑STE: p = 0.071; ∑STD:...Continue Reading
References
Sep 1, 1979·British Heart Journal·S YusufP Sleight
Oct 1, 1990·Circulation·J L WillemsM Verstraete
Sep 1, 1986·Circulation·M Cohen, K P Rentrop
Apr 1, 1988·The American Journal of Cardiology·H R AldrichG S Wagner
Jul 1, 1986·Circulation·N J LemboR A O'Rourke
Sep 1, 1984·Journal of the American College of Cardiology·M HaraphongseB I Jugdutt
Feb 1, 1982·Circulation·G S WagnerR H Selvester
Dec 1, 1995·Journal of the American College of Cardiology·R SchröderW Meyer-Sabellek
Jul 1, 1996·Journal of Molecular and Cellular Cardiology·Y BirnbaumR A Kloner
Dec 24, 1997·JAMA : the Journal of the American Medical Association·W D WeaverF Ribichini
Feb 12, 1998·JAMA : the Journal of the American Medical Association·W R HathawayR M Califf
Oct 25, 2000·Circulation·D A MorrowE Braunwald
May 22, 2002·Journal of the American College of Cardiology·Francesco MauriLuigi Santoro
Jan 9, 2003·Lancet·Ellen C KeeleyCindy L Grines
Nov 1, 2006·Circulation·Duane S PintoC Michael Gibson
Oct 13, 2007·Heart·M TomaP Armstrong
Sep 10, 2008·Circulation·Christopher E BullerPaul W Armstrong
Dec 3, 2009·European Heart Journal·Michael C TjandrawidjajaUNKNOWN APEX-AMI Investigators
Jul 6, 2010·American Heart Journal·Paul W ArmstrongUNKNOWN STREAM Steering Committee
Dec 20, 2011·Circulation·Paul W ArmstrongLars Wallentin
Aug 28, 2012·European Heart Journal·UNKNOWN Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC)Doron Zahger
Mar 12, 2013·The New England Journal of Medicine·Paul W ArmstrongUNKNOWN STREAM Investigative Team