052 Determinants of st segment resolution after primary pci for stemi

ObjectivesST segment resolution (STR) is a recognized intermediate prognosis parameter in STEMI reflecting the quality of tissue reperfusion. The aim of our study was to identify clinical, biological and angiographic determinants of STR.Methods157 consecutive patients treated by primary PCI within 6 hours of symptom onset were included. STR was calculated in the lead with maximal ST segment elevation. Complete STR was defined as a regression more than 70%.ResultsMean age of the population was 58,7±13,7 ans, the sex ratio 4 men for one woman. Maximal ST segment elevation was 0,33±0,18 mV before and 0,16Âc0,19 mV 59± minutes after PCI. Complete STR was achieved in 43,3% of patients. STR significantly correlated with enzymatic peak CPK (r= -0,33 p<0,00001), peak troponine I (r= -0,26 p=0,01), echographic LVEF (r=0,35 p<0,0001) and plasmatic creatinin concentration 48 hours after admission (r= -0,31 p=0,0001). In univariate analysis, complete STR was significantly associated with young age, an elevated SpO2, angiographic TIMI flow grade 2 or 3 before angioplasty, low plasmatic BNP or HbA1c or fibrinogen concentrations. A trend of association for complete STR was observed with Killip class (p=0,075), number of Q waves (p=0,075), the use of direct stenting (p=0,08) and the use of abciximab (p=0,07). In multivariate analysis the independant predictors of STR were inferior location of infarction (OR=1,35 ; IC 1,16-1,55), TIMI risk score<5 (OR=1,24 ; IC 1,05-1,59) and angiographic TIMI flow grade 2 or 3 before angioplasty (OR=1,07 IC 1,009-1,15).ConclusionOur results suggest that STR is related to the size of myocardial infarction. The resolution of ST elevation is multifactorial and mainly deriven by inferior location of myocardial infarction, low TIMI risk score and better angiographic TIMI flow grade before PCI (>1)