THE INFLUENCE OF THE RESOLUTION OF RECIPROCAL ST SEGMENT CHANGES ON IN-HOSPITAL COMPLICATIONS OF ACUTE MYOCARDIAL-INFARCTION AFTER PERCUTANEOUS CORONARY ANGIOPLASTY

We studied 120 patients (M:F 105:15, mean age 57.5 +/- 10.1 years) wit h acute myocardial infarction (MI) successfully treated with percutane ous coronary angioplasty (PTCA) to analyze the influence of the resolu tion of the ST segment elevation and depression after intervention to 1 month composite endpoints of reinfarction or reocclusion, developmen t of congestive heart failure (CF) and death. Sum of preintervention a nd postintervention ST segment elevation and depression and the rate o f resolution of these ST segment elevations and depressions were recor ded for every patient. A total of 17 (14.2 %) composite endpoint event s (events group) were recorded (7 reocclusion or recurrent MI, 9 CF, a nd 1 death). On univariate analysis, events group patients were older (53.3 +/- 9.9 vs. 58.8 +/- 9.1 years, P = 0.032), had lesser resolutio n of ST segment elevations (85 +/- 24 % vs. 44 +/- 55%, P = 0.017) and depression (72 +/- 26% vs. 52 +/- 30%, P = 0.009), had greater preint ervention ST segment elevation (17.49 +/- 12.95 mm vs. 28.38 +/- 20.41 mm, P = 0.045), had lower ejection fraction (59.3 +/- 10.2% vs. 43.6 +/- 9.4%, P < 0.001), and had more frequent multivessel disease (71% v s. 47%, P = 0.048) compared to the nonevents group. Time from angina t o reperfusion, residual stenosis, sex, infarct location and infarct-re lated vessel distribution were similar. On multivariate analysis (logi stic regression with backward likelihood ratio) only older age (P = 0. 0752), lesser rate of resolution of ST segment depression (P = 0.0262) and lower ejection fractions (P = 0.0014) were retained as predictors of the composite endpoints. Relative risk conferred by less than 50% resolution of ST segment depressions for composite endpoints were 3.78 (95% CI 1.63-8.73). We conclude that the lack of resolution of the su m of reciprocal ST segment depressions identifies a subgroup of acute MI patients with greater morbidity after primary PTCA. Cathet Cardiova sc. Diagn. 45:240-245, 1998. (C) 1998 Wiley-Liss, Inc.