Resolution of ST-Segment Depression In Reciprocal Leads As Predictor Mayor Adverse Cardiac Event For ST-Segment Elevation Myocardial Infarction With Fibrinolytic Therapy

Majalah Kardiologi Indonesia Pub Date : 2019-09-11 DOI:10.30701/ijc.v39i2.735

Aldino Satria Adhitya, A. Sitepu, Zulfikri Mukhtar, H. Hasan

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Abstract

Background: ST Elevation Myocardial Infarction (STEMI) may cause Major Cardiovascular Event (MACE). Revascularization needs to be done in all STEMI patients to restore coronary blood flow, hence saving myocardial perfusion. ST Segment Depression (STSD) in reciprocal ECG lead is associated with poor prognosis in STEMI patients receiving fibrinolytic therapy. The main purpose of this study is to evaluate MACE in STEMI patients receiving fibrinolytic therapy using resolution in STSD. Methods: This cohort prospective study with 60 subjects of STEMI patients which are evaluated for MACE (death, heart failure, and rehospitalization) within 30 days after myocardial infarction. Resolution in STSD is defined as resolution ≥ 50% STSD in reciprocal leads within 90 minutes after fibrinolytic therapy.Results: Bivariate analysis showed that Ejection fraction (EF) <40% with OR 8,32 (2,11-32,74), p=0,001; smoking with OR 4,17 (1,05-16,57), p=0,034; Anterior STEMI with OR 3,94 (1,11-13,90), p= 0,027; Creatinine > 1,97 mg/dl with OR 3,69 (1,18-11,55), p= 0,022; complete outpatient medication with OR 5,23 (1,61-17,01), p= 0,004; fragmented QRS with OR 5,23 (1,61-17,01), p= 0,001; resolution in STSD with OR 26,35 (5,16-134, 40), p=<0,001; resolution in ST Segment Elevation with OR 10,5 (2,97-37,24), p=<0,001; are proven to be determining factor for MACE within 30 days. Multivariate analysis showed that among those determining factors for MACE, resolution in STSD on reciprocal leads is evidently the most dominant factor for predicting MACE within 30 days in STEMI patients receiving fibrinolytic therapy [OR 11.47 (1.14-115.10), p=0.038].Conclusion: There is significant difference in MACE within 30 days after myocardial infarction (MI) between patients with and without resolution in STSD. The subjects without resolution in STSD showed higher MACE incidence. Resolution in STSD is evidently an independent predictor for MACE within 30 days after myocardial infarction in STEMI patients.Keywords: Resolution in STSD, MACE, STEMI, Fibrinolytic

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st段抬高型心肌梗死伴纤溶治疗时，st段降低导联的消退可作为主要不良心脏事件的预测因子

背景:ST段抬高型心肌梗死(STEMI)可能导致重大心血管事件(MACE)。所有STEMI患者均需行血运重建以恢复冠状动脉血流，从而节省心肌灌注。在接受纤溶治疗的STEMI患者中，互惠心电图导联ST段压低(STSD)与预后不良相关。本研究的主要目的是评估STEMI患者在接受STSD溶栓治疗时的MACE。方法:对60例STEMI患者进行队列前瞻性研究，这些患者在心肌梗死后30天内进行MACE(死亡、心力衰竭和再住院)评估。STSD消退定义为纤溶治疗后90分钟内相互导联STSD消退≥50%。结果:双因素分析显示，射血分数(EF)为1.97 mg/dl, OR为3.69 (1,18-11,55)，p= 0.022;完成门诊用药的OR为5,23 (1,61-17,01)，p= 0,004;碎片化QRS, OR为5,23 (1,61-17,01)，p= 0,001;STSD的分辨率，OR为26,35 (5,16- 134,40)，p=< 0.001;ST段高程分辨率，OR为10,5 (2,97-37,24)，p=< 0.001;在30天内被证明是MACE的决定因素。多因素分析显示，在MACE的决定因素中，STSD在相互导联上的消退显然是预测接受纤溶治疗的STEMI患者30天内MACE的最主要因素[OR 11.47 (1.14-115.10)， p=0.038]。结论:STSD患者与非STSD患者心肌梗死后30天MACE差异有统计学意义。STSD无消退者MACE发生率较高。STSD消退明显是STEMI患者心肌梗死后30天内MACE的独立预测因子。关键词:STSD, MACE, STEMI，纤溶

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Majalah Kardiologi Indonesia

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8 weeks