Health science reports · 2026
Relationship Between ST-Segment Resolution and Clinical Outcomes After Primary Percutaneous Coronary Intervention of Bifurcation Lesion in Patients With ST Elevation Myocardial Infarction: A Cohort Study.
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Mirzamohamadi Sara, Ashraf Haleh, Hekmat Hamidreza, Saleh Shahrokh Karbalai, Saadat Naser, Soleimani Abbas
Аннотация
BACKGROUND AND AIMS: ST resolution (STR) is associated with improved cardiac outcomes after primary percutaneous coronary intervention (PPCI) and is a marker of success. In this study, we aimed to determine the relationship between the STR degree and outcomes after coronary bifurcation PPCI.
METHODS: This cohort study was conducted at Sina Hospital, Tehran, Iran, from January 11, 2017, to March 20, 2022. Studied variables included age, sex, diabetes mellitus, hypertension, smoking, dyslipidemia, bifurcation type, bifurcation classification, PPCI strategy, type of MI, culprit vessel, door to device time, contrast volume, post PPCI thrombolysis in myocardial infarction, cardiac death, major adverse cardiovascukar events, type of stent, ejection fraction (EF), and STR. Follow-up was performed for every patient from the PPCI date until November 2022 to 2022 November, with a 34 ± 25 (median ± IQR) months. STR was calculated as maximum ST elevation (max STE) from the 90 -min ECG after PPCI.
RESULT: EF in the low-risk group was higher than in the medium- and high-risk groups. Patients with inferior MI were at lower risk than those with anterior MI. The right coronary artery and left circumflex as the culprit vessels had a lower STR than the left anterior descending artery (LAD). Multiple logistic regression showed that PPCI in the main vessel (MV)/side branch (SB) increased cardiac death 6.43 times more than intervention in MV [OR: 4.637, 95% CI (1.021-21.055), p = 0.047]. Additionally, high-risk STR increased the chance of cardiac death 5.83 times more than low-risk [OR: 5.833, 95% CI (1.215-28.006), p = 0.028]. Medium-risk STR and LAD as a culprit vessel were predictors of EF less than 50% [OR: 3.462, 95% CI (1.345-8.91), p = 0.01], [OR: 5.237, 95% CI (1.091-25.143), p = 0.039], respectively.
CONCLUSION: In bifurcation lesions, in addition to the STR, the MV/SB intervention strategy was another predictor of cardiac death. Also, STR was a predictor of EF.
METHODS: This cohort study was conducted at Sina Hospital, Tehran, Iran, from January 11, 2017, to March 20, 2022. Studied variables included age, sex, diabetes mellitus, hypertension, smoking, dyslipidemia, bifurcation type, bifurcation classification, PPCI strategy, type of MI, culprit vessel, door to device time, contrast volume, post PPCI thrombolysis in myocardial infarction, cardiac death, major adverse cardiovascukar events, type of stent, ejection fraction (EF), and STR. Follow-up was performed for every patient from the PPCI date until November 2022 to 2022 November, with a 34 ± 25 (median ± IQR) months. STR was calculated as maximum ST elevation (max STE) from the 90 -min ECG after PPCI.
RESULT: EF in the low-risk group was higher than in the medium- and high-risk groups. Patients with inferior MI were at lower risk than those with anterior MI. The right coronary artery and left circumflex as the culprit vessels had a lower STR than the left anterior descending artery (LAD). Multiple logistic regression showed that PPCI in the main vessel (MV)/side branch (SB) increased cardiac death 6.43 times more than intervention in MV [OR: 4.637, 95% CI (1.021-21.055), p = 0.047]. Additionally, high-risk STR increased the chance of cardiac death 5.83 times more than low-risk [OR: 5.833, 95% CI (1.215-28.006), p = 0.028]. Medium-risk STR and LAD as a culprit vessel were predictors of EF less than 50% [OR: 3.462, 95% CI (1.345-8.91), p = 0.01], [OR: 5.237, 95% CI (1.091-25.143), p = 0.039], respectively.
CONCLUSION: In bifurcation lesions, in addition to the STR, the MV/SB intervention strategy was another predictor of cardiac death. Also, STR was a predictor of EF.