AI Article Synopsis
- The study assessed the risk assessment tools for patients with STEMI (a type of heart attack) by analyzing the effects of two ECG patterns: evolving myocardial infarction (EMI) and preinfarction syndrome (PIS) on patient outcomes.
- Out of 7860 patients, those with the EMI pattern had a higher occurrence of serious complications like death or heart failure within a year (10.4%) compared to those with the PIS pattern (6.1%).
- The research concluded that while patients with EMI are at greater risk, using manual thrombectomy during treatment did not significantly lower the risk, suggesting that ECG classification can help prioritize treatment for patients needing urgent care.
Article Abstract
Background: Useful tools for risk assessment in patients with STEMI are needed. We evaluated the prognostic impact of the evolving myocardial infarction (EMI) and the preinfarction syndrome (PIS) ECG patterns and determined their correlation with angiographic findings and treatment strategy.
Methods: This substudy of the randomized Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL) included 7860 patients with STEMI and either the EMI or the PIS ECG pattern. The primary outcome was a composite of death from cardiovascular causes, recurrent MI, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within one year.
Results: The primary outcome occurred in 271 of 2618 patients (10.4%) in the EMI group vs. 322 of 5242 patients (6.1%) in the PIS group [AdjustedHR, 1.54; 95% CI, 1.30 to 1.82; p < .001]. The primary outcome occurred in the thrombectomy and PCI alone groups in 131 of 1306 (10.0%) and 140 of 1312 (10.7%) patients with EMI [HR 0.94; 95% CI, 0.74-1.19] and 162 of 2633 (6.2%) and 160 of 2609 (6.1%) patients with PIS [HR 1.00; 95% CI, 0.81-1.25], respectively (p = 0.679).
Conclusions: Patients with the EMI ECG pattern proved to have an increased rate of the primary outcome within one year compared to the PIS pattern. Routine manual thrombectomy did not reduce the risk of primary outcome within the different dynamic ECG patterns. The PIS/EMI dynamic ECG classification could help to triage patients in case of simultaneous STEMI patients with immediate need for pPCI.
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| http://dx.doi.org/10.1016/j.ijcard.2020.05.053 | DOI Listing |
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