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Acute coronary syndromes
Risk stratification in ST-elevation myocardial infarction is enhanced by combining baseline ST deviation and subsequent ST-segment resolution
  1. M Toma1,
  2. Y Fu1,
  3. G Wagner2,
  4. S G Goodman3,
  5. C Granger2,
  6. L Wallentin4,
  7. F Van de Werf5,
  8. P Armstrong1
  1. 1
    University of Alberta, Edmonton, Canada
  2. 2
    Duke Clinical Research Institute, Durham, USA
  3. 3
    St Michael’s Hospital, Toronto, Canada
  4. 4
    Uppsala Clinical Research Centre, Uppsala, Sweden
  5. 5
    University Hospital Gasthuisberg, Leuven, Belgium
  1. Professor P W Armstrong, Canadian VIGOUR Centre, 2–51 Medical Sciences Building, University of Alberta, Edmonton AB Canada T6G 2H7; paul.armstrong{at}


Background: The baseline sum of ST deviation (ΣSTD) and ST segment resolution after fibrinolysis for ST-elevation myocardial infarction are prognostically useful.

Objectives: To examine the prognostic impact of ST resolution after fibrinolysis and influence of baseline ST deviation in ASSENT-3.

Methods: ST resolution was determined in 4565 patients at 180 minutes after fibrinolysis. 30-Day and 1-year mortality was assessed in patients with complete (ie, ⩾50%) versus incomplete ST resolution according to absolute baseline ΣSTD.

Results: Patients with complete ST resolution had lower 30-day and 1-year mortality than those with incomplete ST resolution (3.7% vs 7.3%, p<0.001, and 6.1% vs 10.0%, p<0.001, respectively). After multivariable adjustment for key baseline risk factors, patients with anterior myocardial infarction (MI) in the highest quartile of ΣSTD had a greater risk of 30-day and 1-year mortality than those in the lowest quartile in both complete (odds ratio (OR) = 2.34, 95% CI 1.14 to 4.80, and OR = 2.34, 95% CI 1.26 to 4.34, respectively) and incomplete ST resolution groups (OR = 4.97, 95% CI 1.82 to 13.61, and OR = 3.61, 95% CI 1.55 to 8.4, respectively). However, in patients with inferior MI this pattern only existed when ST resolution was incomplete (OR = 4.88, 95% CI 1.65 to 14.39, and OR = 4.34, 95% CI 1.66 to 11.37, respectively).

Conclusion: These findings indicate that percentage ST resolution alone is an incomplete guide to 30-day and 1-year mortality. The integration of both the baseline and post-fibrinolysis ECG provides better risk assessment and can assist in the triage and treatment of such patients.

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  • Funding: Boehringer-Ingelheim, Germany, Genentech, South San Francisco, CA, USA, Aventis, Bridgewater, NJ, USA.

  • Competing interests: None.

  • Ethics approval: Obtained.