CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 9, October 2012
AFRICA
495
Comparison of outcomes in ST-segment depression
and ST-segment elevation myocardial infarction patients
treated with emergency PCI: data from a multicentre
registry
JIRI KNOT, PETR KALA, RICHARD ROKYTA, JOSEF STASEK, BOYKO KUZMANOV, OTA HLINOMAZ,
JAN BĚLOHLAVEK, FILIP ROHAC, ROBERT PETR, DANA BILKOVA, SLAVEJKO DJAMBAZOV,
MLADEN GRIGOROV, PETR WIDIMSKY
Abstract
Background:
Traditionally, acute myocardial infarction
(
AMI) has been described as either STEMI (ST-elevation
myocardial infarction) or non-STEMI myocardial infarction.
This classification is historically related to the use of throm-
bolytic therapy, which is effective in STEMI. The current era
of widespread use of coronary angiography (CAG), usually
followed by primary percutaneous coronary intervention
(
PCI) puts this classification system into question.
Objectives:
To compare the outcomes of patients with STEMI
and ST-depression myocardial infarction (STDMI) who were
treated with emergency PCI.
Methods:
This multicentre registry enrolled a total of 6 602
consecutive patients withAMI. Patients were divided into the
following subgroups: STEMI (
n
=
3446),
STDMI (
n
=
907),
left bundle branch block (LBBB) AMI (
n
=
241),
right bundle
branch block (RBBB)AMI (
n
=
338)
and other electrocardio-
graphic (ECG) AMI (
n
=
1670).
Baseline and angiographic
characteristics were studied, and revascularisation therapies
and in-hospital mortality were analysed.
Results:
Acute heart failure was present in 29.5% of the
STDMI vs 27.4% of the STEMI patients (
p
<
0.001).
STDMI
patients had more extensive coronary atherosclerosis than
patients with STEMI (three-vessel disease: 53.1 vs 30%,
p
<
0.001).
The left main coronary artery was an infract-related
artery (IRA) in 6.0% of STDMI vs 1.1% of STEMI patients
(
p
<
0.001).
TIMI flow 0–1 was found in 35.0% of STDMI
vs 66.0% of STEMI patients (
p
<
0.001).
Primary PCI was
performed in 88.1% of STEMI (with a success rate of 90.8%)
vs 61.8% of STDMI patients (with a success rate of 94.5%)
(
p
=
0.012
for PCI success rates). In-hospital mortality was
not significantly different (STDMI 6.3 vs STEMI 5.4%,
p
=
0.330).
Conclusion:
These data suggest that similar strategies (emer-
gency CAG with PCI whenever feasible) should be applied to
both these types of AMI.
Keywords:
coronary artery disease, acute myocardial infarction,
primary PCI
Submitted 3/10/11, accepted 8/6/12
Cardiovasc J Afr
2012;
23
: 495–500
DOI: 10.5830/CVJA-2012-053
ST-segment elevation (STEMI) and ST-segment depression
(
STDMI) myocardial infarctions have a common pathogenesis
–
a vulnerable plaque ruptures, followed by luminal thrombus
formation.
1-4
Thrombosis may lead to rapid changes in the
severity of coronary artery stenosis, which may cause subtotal
or total vessel occlusion. The thrombus may completely occlude
the major epicardial coronary artery in cases of STEMI,
5
or
cause partial or intermittent vessel occlusion in cases of non-ST-
elevation myocardial infarction (NSTEMI).
6
This traditional classification of patients with acute myocardial
infarction (AMI), based on baseline electrocardiographic (ECG)
recordings, has practical implications for guidelines and in
clinical practice especially, as it refers to the use of reperfusion
therapy. The separation of STEMI from other types of acute
myocardial infarction has its historical roots in the thrombolytic
era.
The current widespread use of primary percutaneous
coronary intervention (pPCI) makes use of modified reperfusion
treatment for myocardial infarction patients. Recently published
randomised trials and meta-analyses,
7-12
as well as the guidelines
of the European Society of Cardiology (ESC) for myocardial
infarction in patients presenting with persistent ST-segment
Third Faculty of Medicine, Charles University, Prague,
Czech Republic
JIRI KNOT, MD,
FILIP ROHAC, MD,
ROBERT PETR, MD
DANA BILKOVA, MD
PETR WIDIMSKY, MD, DSc
JAN BĚLOHLAVEK, MD, PhD
Faculty Hospital, Brno, Masaryk University, Czech Republic
PETR KALA, MD, PhD
Faculty of Medicine, Pilsen, Charles University Prague,
Czech Republic
RICHARD ROKYTA, MD, PhD
Faculty of Medicine, Hradec Kralove, Charles University
Prague, Czech Republic
JOSEF STASEK, MD, PhD
UniCardio Clinic Pleven, Bulgaria
BOYKO KUZMANOV, MD
SLAVEJKO DJAMBAZOV, MD
MLADEN GRIGOROV, MD PhD
Faculty Hospital St Anne, Masaryk University, Brno, Czech
Republic
OTA HLINOMAZ, MD, PhD
