Abstract 13275: Pre-angiography Total ST-segment Resolution is a Poor predictor of an Open Infarct-Related Artery
Whilst the cutoffs of predictive value for ST-segment resolution (STSR) following thrombolysis and/or PCI were well documented, the impact of pre-angiography STSR has not been established yet.
Aim of the study: To assess prognostic utility of pre-angiography total ST-segment resolution (STSR) to predict pre-procedural TIMI flow ≥2 in the infarct-related artery (IRA) in STEMI patients undergoing primary PCI.
Material and methods: Prospective study was performed on 310 out of 596 patients admitted within 12 hours from symptom onset who underwent primary PCI. ST-segment elevations were measured in: (1) qualifying ECG, (2) ECG before angiography, (3) ECG performed 60 min post PCI. STSR was define as: total (≥70%), partial (between 70% and 30%) and none (<30%). Relationships between pre-angiography STSR and TIMI flow were analyzed.
Results: Pre-angiography STSR correlated with initial TIMI flow in the IRA (rS = 0.619; p<0.001). Pre-angiography total STSR was observed in 23.2% (72/310) patients, partial in 20% (62/310) and lack of STSR in 56.8% (176/310) patients. Pre-angiography total STSR was noted in 79.2% of patients with pre-procedural TIMI flow ≥2 and in 20.8% with TIMI flow ≤1 (p<0.001). Although sensitivity of pre-angiography total STSR to detect pre-procedural TIMI flow ≥2 was 93%, its specificity was low - table. Using ROC analysis we identified a cutoff value for pre-angiography STSR that predicted initial TIMI flow ≥2 with similar sensitivity to that obtained for the pre-specified 70% threshold but higher specificity, which, however, did not exceed 75% - table.
Conclusions: 1. Pre-angiography STSR correlates with pre-procedural TIMI flow.
2. Sensitivity of pre-angiography total STSR for detection of pre-procedural TIMI flow ≥2 is high, but low specificity of only 56% makes it a poor predictor of open IRA. Thus immediate angiography in STEMI patients should not be withheld based on confirmed pre-angiography total STSR.
- © 2013 by American Heart Association, Inc.