Abstract 6180: Resolution of ST-Segment Depression: A New Prognostic Marker of Clinical Outcome in ST-Segment Elevation Myocardial Infarction
Early ST elevation resolution (STE-R) following reperfusion for STEMI predicts outcomes. What role concomitant ST depression resolution (STD-R) contributes is unclear. We hypothesized that early STD-R after primary PCI risk further stratifies patients (pts) independent of STE-R. In APEX-AMI 4729 pts who underwent primary PCI had analyzable ECGs. Resolution of ΣSTE and ΣSTD 30-min post-PCI ECGs (core-lab) was dichotomized into ≥50% vs. <50% resolution consistent with ACC/AHA STEMI guidelines. Associations among STD-R, STE-R and 90-day mortality and composite of death, shock and CHF were assessed using multivariable Cox proportional hazards regression adjusting for baseline characteristics. Resolution of ΣSTD was more common in pts with STE-R >50% (83.6%) than those without (55.6%, p <0.001). STD-R<50% was associated with higher risk pt characteristics i.e. older age, female sex, diabetes and worse Killip class (Table⇓). This was preserved after adjustment of key prognostic indicators including HR, SBP, and infarct location, as well as STE-R status. STD-R<50% was also associated with impaired TIMI culprit flow after PCI. This was accentuated in those with STE-R <50%. Among pts with STE-R≥50%, triple-vessel disease was more common in pts with STD-R<50%. Irrespective of STE-R, STD-R<50% was associated with higher 90-d death and composite outcomes. Less than 50% STD-R after PCI for STEMI was independently associated with worse 90-d outcomes. STD-R may be particularly useful in further partitioning pt risk with STE-R≥50% for whom favorable outcomes are generally anticipated. This metric deserves consideration in future STEMI studies.