Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Combined Assessments of Biochemical Markers and ST-Segment Resolution Provide Additional Prognostic Information for Patients With ST-Segment Elevation Myocardial Infarction

  • Woo, Jong-Shin (Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyung Hee University) ;
  • Cho, Jin-Man (Cardiovascular Center of Kyung Hee University, Gang Dong Kyung Hee Medical Center) ;
  • Kim, Soo-Joong (Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyung Hee University) ;
  • Kim, Myeong-Kon (Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyung Hee University) ;
  • Kim, Chong-Jin (Cardiovascular Center of Kyung Hee University, Gang Dong Kyung Hee Medical Center)
  • Published : 2011.07.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: The prognostic value of biochemical markers and the resolution of ST-segment elevation on electrocardiogram are well established. However, how a combination of these two tools affects the evaluation of risk stratification has not yet been evaluated. Subjects and Methods: Between January 2006 and June 2008, 178 consecutive patients treated with primary percutaneous coronary interventions after ST-segment elevation myocardial infarctions (STEMI) were analyzed at two coronary care units. Patients were divided into the following three groups according to ST-segment resolution: complete (${\geq}$70% depression of the elevated ST-segment, n=63), partial (30% to 70%, n=90), and incomplete (<30%, n=25). Demographic data, including history, electrocardiography, biochemical markers, initial ejection fraction, and angiographic findings were also evaluated. Results: There were 7 deaths, 3 repeated myocardial infarctions, and 17 readmissions for worsening heart failure during six months of follow-up. In a multivariate analysis to predict clinical outcomes, ejection fraction {hazard ratio (HR): 0.83 (0.76-0.91), p<0.01}, high-sensitivity C-reactive protein {HR: 1.15 (1.05-1.26), p<0.05}, and the degree of ST-segment resolution {HR: 0.96 (0.93-0.09), p<0.05} were independently associated with clinical outcomes. According to the Cox-proportional hazards model, the addition of ST-segment resolution markedly improved the prognostic utility of the model containing biochemical markers and ejection fraction. Conclusion: Assessment of biomarkers upon admission and ST-segment resolution are strong predictors of clinical outcomes. The combination of these data provides additive information about prognosis at an early point in the disease progression and further improves risk stratification for STEMI.

Keywords

References

  1. Morrow DA, Braunwald E. Future of biomarkers in acute coronary syndromes: moving toward a multimarker strategy. Circulation 2003; 108:250-2. https://doi.org/10.1161/01.CIR.0000078080.37974.D2
  2. Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. N Engl J Med 2000;343: 1139-47. https://doi.org/10.1056/NEJM200010193431602
  3. Bjorklund E, Lindahl B, Johanson P, et al. Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction. Eur Heart J 2004; 25:113-20. https://doi.org/10.1016/j.ehj.2003.10.025
  4. Choe HM, Yoo BS, Ryu HY, et al. The early changing pattern of the B-type natriuretic peptide concentration and its significance as a prognostic marker after acute myocardial infarction. Korean Circ J 2006; 36:526-34. https://doi.org/10.4070/kcj.2006.36.7.526
  5. Foussas SG, Zairis MN, Lyras AG, et al. Early prognostic usefulness of C-reactive protein added to the Thrombolysis In Myocardial Infarction risk score in acute coronary syndromes. Am J Cardiol 2005;96: 533-7. https://doi.org/10.1016/j.amjcard.2005.04.015
  6. Hong YJ, Jeong MH, Park OY, et al. The role of C-reactive protein on the long-term clinical outcome after primary or rescue percutaneous coronary intervention. Korean J Intern Med 2003;18:29-34. https://doi.org/10.3904/kjim.2003.18.1.29
  7. Bae EH, Lim SY, Jeong MH, et al. Long-term predictive factors of major adverse cardiac events in patients with acute myocardial infarction complicated by cardiogenic shock. Korean J Intern Med 2005; 20:8-14. https://doi.org/10.3904/kjim.2005.20.1.8
  8. Mega JL, Morrow DA, De Lemos JA, et al. B-type natriuretic peptide at presentation and prognosis in patients with ST-segment elevation myocardial infarction: an ENTIRE-TIMI-23 substudy. J Am Coll Cardiol 2004;44:335-9. https://doi.org/10.1016/j.jacc.2004.04.033
  9. Staub D, Nusbaumer C, Zellweger MJ, et al. Use of B-type natriuretic peptide in the detection of myocardial ischemia. Am Heart J 2006;151: 1223-30. https://doi.org/10.1016/j.ahj.2005.06.045
  10. Schroder R, Dissmann R, Bruggemann T, et al. Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction. J Am Coll Cardiol 1994; 24:384-91. https://doi.org/10.1016/0735-1097(94)90292-5
  11. McLaughlin MG, Stone GW, Aymong E, et al. Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. J Am Coll Cardiol 2004;44:1215-23.
  12. De Luca G, Maas AC, Suryapranata H, et al. Prognostic significance of residual cumulative ST-segment deviation after mechanical reperfusion in patients with ST-segment elevation myocardial infarction. Am Heart J 2005;150:1248-54. https://doi.org/10.1016/j.ahj.2005.01.056
  13. Lindahl B, Venge P, Wallentin L. Troponin T identifies patients with unstable coronary artery disease who benefit from long-term antithrombotic protection. Fragmin in Unstable Coronary Artery Disease (FR-ISC) Study Group. J Am Coll Cardiol 1997;29:43-8. https://doi.org/10.1016/S0735-1097(96)00447-0
  14. Omland T, Persson A, Ng L, et al. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation 2002;106:2913-8. https://doi.org/10.1161/01.CIR.0000041661.63285.AE
  15. Cameron SJ, Sokoll LJ, Laterza OF, Shah S, Green GB. A multi-marker approach for the prediction of adverse events in patients with acute coronary syndromes. Clin Chim Acta 2007;376:168-73. https://doi.org/10.1016/j.cca.2006.08.019
  16. Tomoda H, Aoki N. Prognostic value of C-reactive protein levels within six hours after the onset of acute myocardial infarction. Am Heart J 2000;140:324-8. https://doi.org/10.1067/mhj.2000.108244
  17. Nikfardjam M, Mullner M, Schreiber W, et al. The association between C-reactive protein on admission and mortality in patients with acute myocardial infarction. J Intern Med 2000;247:341-5. https://doi.org/10.1046/j.1365-2796.2000.00670.x
  18. Zairis MN, Manousakis SJ, Stefanidis AS, et al. C-reactive protein levels on admission are associated with response to thrombolysis and prognosis after ST-segment elevation acute myocardial infarction. Am Heart J 2002;144:782-9. https://doi.org/10.1067/mhj.2002.125622