Abstract 18006: The Relationship Between Residual ST-segment Deviation and Biomarkers in Patients with STEMI Undergoing Primary PCI: A Sub-analysis of the On-TIME 2 Trial
Background: Pre-hospital initiation of High-bolus Dose Tirofiban (HDT) improves ST-segment resolution before and after pPCI which is associated with improved clinical outcome at 30 day follow-up. We investigated the relation between residual ST-segment deviation (STres) and several known biomarkers of myocardial necrosis and heart failure
Methods: In On-TIME 2, 984 patients presenting with STEMI were randomized in the ambulance to either high-bolus dose tirofiban or placebo in addition to aspirin (500 mg), heparin (5000 IU), and clopidogrel (600 mg). The primary end point was the extent of STres 1 hour after pPCI with a cut-off at 3 mm. Blood samples were taken at the time of the pPCI (baseline), 18–24 and 72–96 hours thereafter. Mean cardiac troponin T, NT-proBNP (two assays) and CK-max levels were analyzed in relation to high STres(> 3mm) 1 hour after pPCI.
Results: Early initiation of HDT significantly reduced the percentage of patients with high STres (HDT 172/451 (38.1%), placebo: 205/455 (45.1%), p=0.035). Patients high STres had significantly higher levels of cardiac troponin T (0.58 ± SD 1.59 vs. 0.20 ± SD 0.80; p<0.001) and NT-proBNP (A: 2389 ± SD 2042 vs. 333 ± SD 894; p<0.001; B: 1053 SD ± 2784 vs 338 ± SD 905; p<0.001) at baseline. These biomarkers remained significantly higher even 3–4 days after pPCI, troponin T (3.08 ± SD 2.55vs. 1.63 ± SD 1.77; p<0.001) and NT-proBNP (A: 2746 ± SD 6480 vs. 1169 ± SD 2001; p<0.001; B: 2699 ± SD 4461 vs 1257 ± SD 2125; p<0.001) . Also mean CK-max was significantly higher in patients with high STres (2389 ± 2042 vs. 1279 ± SD 1423; p<0.001).
Conclusions: Residual ST-segment deviation of more than 3 mm one hour after pPCI is associated with significantly higher levels of biomarkers indicative of myocardial necrosis or heart failure both before and after pPCI. This simple electrocardiographic marker for which only one 12 lead ECG is required may help in risk stratifying STEMI patients early after pPCI
- © 2010 by American Heart Association, Inc.