ASSOCIATION OF RESOLUTION OF SUM ST-SEGMENT DEVIATION WITH MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION AFTER REPERFUSION

Abstract

Background: The incidence of acute myocardial infarction with ST-segment elevation (STEMI) causes an infarct area which expansion can be reduced by reperfusion strategies. The infarct size can predict major cardiovascular events (MACE). The changes of ST-segment on electrocardiography (ECG) are one of the modalities for assessing infarct size. Resolution of sum ST-segment deviations occurring in STEMI has been associated with worse clinical outcome although the mechanism is uncertain.

Objective: To determine the relationship between the resolution of the number of ST-segment deviations with major cardiovascular events in STEMI patients undergoing reperfusion.

Research Methods: Analytical observational study with ambi-directional cohort using secondary data at RSUP Dr. Sardjito were conducted in July 2019-June 2022. The STEMI patient undergoing reperfusion were enlisted, either primary PCI or pharmacoinvasive. The data was including basic characteristics, ECG, reperfusion data, and clinical outcomes. Resolution of sum ST-segment deviations were obtained from the percentage of diagnostic ECG and post-reperfusion ECG to the sdiagnostic ECG. Resolution is significant if ≥50% and not significant if <50%.

Results: Of a total 140 subjects, 92 subjects experienced MACE and 48 subjects did not. In subjects with significant resolution, there was no significant in MACE (70.5% vs. 70.8%, p=0.774). In multivariate analysis, left ventricular ejection fraction (OR 0.73; 95% CI 0.65-0.82; p=0.001) and TIMI flow after PCI (OR 0.28; 95% CI 0.09-0.9; p=0.033) significantly affect MACE. In the sub-analysis of the resolution of sum ST-segment deviations to the MACE components, the results obtained a significant relationship between arrhythmias (p=0.018) and reinfarction (p=0.011).

Conclusion: The significant resolution of sum ST-segment deviations in STEMI patients undergoing reperfusion did not have a significant relationship with MACE.

Keywords: resolution of sum ST-segment deviation, major adverse cardiovascular events, STEMI