045 Predictive factors of ST-segment resolution after primary angioplasty and clinical outcome

In the setting of acute myocardial infarction (AMI), early resolution of ST-segment elevation was a useful predictor of final infarct size, left ventricular function and clinical outcome.Aimto determine the predictive factors of ST-segment resolution immediately following primary coronary angioplasty for AMI.Methodsprimary angioplasty was performed in 270 consecutive patients with first AMI, they were divided into 2 groups according to whether ST-segment resolution occurred 1 hour after the procedure. ST-segment resolution ≥ 70% was considered as ‘complete’ ST-segment resolution, whereas ST-segment resolution < 70% was considered as ‘incomplete’ ST-segment resolution.Resultsof the 270 patients, 156 (57.8%) had complete ST-segment resolution. Patients with pre-infarction angina had a greater degree of ST-segment resolution than those without angina (71 ±21% vs. 49± 43%, p<0.02).On multivariate analysis, the absence of pre-infarction angina (OR=2.7; CI 1.7-3.4, p=0.03) as well as the admission after H4 (OR=3.5; CI 1.58-8.06, p=0.002), patient age ≥ 70 year(OR= 5.6; CI 2.23-14.4, p<0.001) and initial TIMI flow grade 0/1 (OR=13.6; CI 4.5-21.2, p<0.001) were major independent predictors of poor ST-segment resolution; whereas sex, coronary risk factors, killip class on admission, multivessel disease and extent of collaterals were not significant.There was a significant difference in survival free of major adverse cardiovascular events, at multivariate analysis =, incomplete ST-segment resolution was an independent factor of 1-year mortality (p=0.016).ConclusionsRapid ST-segment resolution was associated with a better clinical outcome and prognosis after successful primary PTCA. Pre-infarction angina, age < 70 years, TIMI flow 2/3 and ischemia time < 4 hours were associated with a greater degree of ST-segment resolution after primary angioplasty