Early ST-segment recovery after primary percutaneous coronary intervention accurately predicts long-term prognosis after acute myocardial infarction

Background Several ancillary studies reported on the prognostic value of ST-segment recovery (STR) with measurement at 30 to 240 minutes after primary percutaneous coronary intervention (PCI). We determined the long-term prognostic value of early STR, assessed at the end of primary PCI, in unselected patients after ST-segment elevation myocardial infarction (STEMI). Methods We analyzed 12-lead electrocardiograms, recorded in the catheterization laboratory before arterial puncture and at the time of the end of PCI, from 2,124 STEMI patients who underwent primary PCI at our institution between 2000 and 2007. ST-segment recovery was categorized as complete (>= 70%), partial (30%-70%), or absent (<30%). Median follow-up was 4.1 years. Results The estimated 5-year mortality was 8.3% in patients with complete STR, 14.4% in patients with partial STR, and 22.8% in patients with absent STR (P<.001). Multivariable-adjusted hazard ratios for 1-year death of patients with partial and absent STR, as compared with patients with complete STR, were 2.1 (95% CI 1.2-3.8, P=.014) and 3.2 (95% CI 1.8-5.8, P<.001), respectively. In a landmark analysis restricted to 1-year survivors, early STR was significantly predictive of 5-year mortality, even after multivariable adjustment. Conclusions Early STR assessment has strong, long-term prognostic properties in all-comer STEMI patients. Moreover, the prognostic power of early STR is not restricted to the early recovery phase after STEMI, but identifies high-risk subgroups among 1-year survivors. (Am Heart J 2010; 159: 1005-11.)