Abstract 14862: Prediction of Myocardial Infarct Size Using Multiple Concomitant Angiographic, Biochemical and Electrocardiographic Biomarkers in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention
Background Despite significant improvement in clinical outcome with primary percutaneous coronary intervention (pPCI), ST-segment elevation myocardial infarction (STEMI) remains associated with considerable morbidity and mortality in part due to large myocardial infarct size (IS). Multiple angiographic, biochemical and ECG biomarkers have been shown to be associated with final IS. However, a combination of additive biomarkers may improve prediction over any single biomarker. Therefore, we investigated the most predictive combination of biomarkers to predict IS by single photon emission computed tomography (SPECT).
Methods We analyzed 1501 patients from the CASTEMI, EMERALD, AMIHOT I + II and DELTA-MI trials with STEMI<6 hrs who underwent pPCI with: 12-lead digital Holter monitoring ECG parameters [3 hour ST-segment area under the time-trend curve (ST-AUC), ST-segment recovery at 240 minutes (STR 240) and time to stable ST reperfusion (time to Steady state)]; post-procedural TIMI-flow; CK-MB peak measurement expressed as multiples of the upper limit of normal (ULN) in the first 24 hours; and key clinical descriptors available. Variables were entered in multivariable generalized linear models for their association with log-normal transformed SPECT IS. Improvement in predictive value is expressed as R2 improvement.
Results Median time to SPECT was 12 days (7, 15) and median IS was 14.0 (3, 31). All biomarkers were independently predictive of myocardial IS after adjustment for clinical risk factors (table 1). Addition of biomarkers to clinical characteristics improved the R2 from 0.21 to 0.39 (p<0.001).
Conclusion We found that post-procedural angiographic, biochemical and electrocardiographic) biomarkers significantly improved prediction of IS over clinical variables alone. These findings support the use of multiple biomarkers for robust risk stratification after pPCI and identification of optimal adjuvant treatment to improve clinical outcome.
- © 2011 by American Heart Association, Inc.