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(Circulation. 2001;104:2653.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Time to Treatment Influences the Impact of ST-Segment Resolution on One-Year Prognosis

Insights From the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Trial

Yuling Fu, MD; Shaun Goodman, MD; Wei-Ching Chang, PhD; Frans Van de Werf, MD; Christopher B. Granger, MD; Paul W. Armstrong, MD; , for the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Trial Investigators

From the University of Alberta, Edmonton, Alberta, Canada (Y.F., W.-C.C., P.W.A.); the Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada (S.G.); Universitaire Ziekenhuizen Leuven, Leuven, Belgium (F.V.d.W.); and Duke Clinical Research Institute, Durham, NC (C.B.G.).

Correspondence to Paul W. Armstrong, MD, Division of Cardiology, Department of Medicine, 2-51 Medical Sciences Bldg, University of Alberta, Edmonton, Alberta, Canada, T6G 2H7. E-mail paul.armstrong{at}ualberta.ca

Background— Early ST resolution after reperfusion is a prognostic indicator in acute myocardial infarction. Little information exists regarding the prognostic utility of ST resolution beyond 4 hours after fibrinolysis. Furthermore, the relation between time to treatment, ST resolution at 24 to 36 hours, and 1-year outcome has not been well studied. Accordingly, we undertook a prospective ECG substudy in the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) trial to examine this.

Methods and Results— Patients (n=13 100) were stratified into 3 ST-resolution categories, based on baseline and 24- to 36-hour ECGs: complete resolution (70%) in 6698 (51.1%) patients, partial resolution (30% to 70%) in 4610 (35.2%) patients, and no resolution (<30%) in 1792 (13.7%) patients; 1-year mortality rate was 5.1%, 8.0%, and 9.7%, respectively (P<0.001). Among patients treated <2 hours after symptom onset, 55.6% had complete ST resolution, whereas 52.1% and 43% of patients treated between 2 to 4 hours and 4 to 6 hours, respectively, had complete ST resolution (P<0.001). Within each category of ST resolution, patients treated <2 hours had lower 1-year mortality rates as compared with patients treated between 2 to 4 hours or >4 hours (3.8% versus 5.2% and 6.6%, P=0.002 in complete ST resolution; 5.7% versus 8.4% and 9.9%, P=0.001 in partial ST resolution; 7.1% versus 8.7% and 13%, P=0.006 in no resolution). The extent of ST resolution was closely and inversely correlated with 1-year mortality rates (r=-0.963, P<0.001).

Conclusions— ST resolution at 24 to 36 hours after fibrinolysis is influenced by time to treatment and inversely related to 1-year mortality rates. Time to treatment further differentiates between high- and low-risk patients and further highlights the importance of reducing time delay to initiation of fibrinolysis in acute myocardial infarction.

Key Words: myocardial infarction • fibrinolysis • reperfusion

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