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.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Funding: Boehringer-Ingelheim, Germany, Genentech, South San Francisco, CA, USA, Aventis, Bridgewater, NJ, USA.
Competing interests: None.
Ethics approval: Obtained.