Predictors of ST Depression Resolution in STEMI Patients Undergoing Primary PCI and Its Clinical Significance

Figures & data

Table 1 Clinical, Electrocardiographic, and Laboratory Data in Patients Grouped as STD-R ≥50% and STD-R <50%. The p values are Related to Independent Sample’s t-Test for Continuous Variables and Chi Squared for Categorical Variables

	STD-R <50% (n=52)	STD-R ≥50% (n=127)	P value
Age	57.9±12.53	57.06±13.79	0.7
Male	33 (63.46%)	105 (82.68%)	0.016
Pain to admission (minute)	564±1162	593±1552	0.91
Time from admission to PPCI (minute)	105±91	104±127	0.94
Pain to balloon	669±1216	685±1569	0.95
Diabetes mellitus	19 (36.5%)	27 (21.3%)	0.038
Hypertension	30 (57.7%)	58 (45.7%)	0.19
Hyperlipidemia	7 (13.5%)	21 (16.5%)	0.27
Previous MI	4 (7.7%)	7 (5.5%)	0.55
Positive familial history	6 (11.5%)	19 (15%)	0.38
Smoking	11 (21.2%)	70 (55.1%)	0.0001
EF	33.86±7.51	34.83±6.74	0.39
Mitral Regurgitation more than moderate	10 (19.2%)	26 (20.5%)	0.26
Max ST-E in a single lead in presenting ECG (mV)	4.04±1.95	4.85±3.04	0.07
∑ST-E in presenting ECG (mV)	12.48±7.37	15.30±10.26	0.07
Max ST-D in a single lead in presenting ECG (mV)	1.11±0.62	1.44±0.91	0.015
∑ST-D in presenting ECG (mV)	2.60±1.90	3.52±2.58	0.021
∑ST-E Resolution (percent)	29.15±62.76	44.89±59.06	0.11
ST-E Resolution in lead with max ST-E in presenting ECG (percent)	54.79±27.96	62.23±27.09	0.10
∑ST-D Resolution (percent)	−37.25±131.76	86.13±18.22	0.0001
ST-D Resolution in lead with max ST-D in presenting ECG (percent)	37.24±36.39	89.05±17.75	0.0001
3VD/2VD/1VD	13/15/24	18/38/71	0.15
CTNI	10.66±11.94	11.53±10.16	0.62
CK-MB	182±192	197±341	0.76
WBC	11,162±3934	12,024±3970	0.18
Hb	14.58±2.05	15.40±1.97	0.013
PLT	263,510±78,698	233,680±67,118	0.013
PLT/Lymph	186.84±248.89	136.90±63.01	0.051
Triglyceride	105.91±53.97	118.61±71.70	0.28
LDL	108.78±40.33	107.96±33.33	0.89
HDL	38.93±9.71	36.51±9.26	0.15
VT	2 (3.8%)	9 (7.1%)	0.65
VF	6 (11.5%)	6 (4.7%)	0.23
Mechanical ventilation	4 (7.7%)	7 (5.5%)	0.51
Acute heart failure	18 (34.6%)	27 (21.3%)	0.025
In-hospital mortality	5 (9.6%)	4 (3.1%)	0.19

Abbreviations: ST-D, ST depression; ST-E, ST elevation; STD-R, ST depression resolution; STE-R, ST elevation resolution; PPCI, primary percutaneous intervention; MI, myocardial infarction; EF, ejection fraction; ECG, electrocardiogram; CTNI, cardiac troponin I; CK-MB, creatinine kinase MB; WBC, white blood cells; Hb, hemoglobin; PLT, platelet; PLT/Lymph, platelet to lymphocyte ratio; LDL, low density lipoprotein; HDL, high density lipoprotein; VT, ventricular tachycardia; VF, ventricular fibrillation.

Table 2 Comparison of Patients Grouped as Having STE-R ≥50%, or STE-R <50% for Clinically Important Variables

	STE-R <50%	STE-R ≥50%	χ2	t	P value
Diabetes	22 (23.7%)	38 (30.2%)	3.39		0.183
Smoking	42 (45.2%)	53 (42.1%)	2.48		0.289
Previous MI history	11 (11.8%)	5 (4%)	9.34		0.053
Triglyceride	130±78	105±54		2.52	0.013
Total cholesterol	178±36	163±43		2.45	0.015
LDL	113±34	102±36		2.17	0.031

Abbreviations: STE-R, ST elevation resolution; STD-R, ST depression resolution; MI, myocardial infarction; LDL, low density lipoprotein.

Table 3 Results of Univariate and Multivariate Regression Analyses to Determine Predictive Factors for Sum of ST Depression/Elevation Resolution of More Than 50%

	B(SE)	OR	95% CI	P value
Sigma ST Depression Resolution
Sex	−1.011 (0.371)	0.364	0.176–0.754	0.006
Diabetes	0.757 (0.361)	2.132	1.052–4.323	0.036
Hb	0.203 (0.084)	1.225	1.039–1.444	0.016
Smoking
(univariate analysis)	−1.521 (0.384)	0.218	0.103–0.463	<0.001
(multivariate analysis)	−1.442 (0.447)^*	0.236	0.098–0.567	0.001
PLT*10^3
(univariate analysis)	−0.006 (0.002)	0.994	0.990–0.999	0.016
(multivariate analysis)	−0.005 (0.003)	0.995	0.990–0.999	0.050
Sigma ST Elevation Resolution
Previous MI History
(univariate analysis)	1.178 (0.558)	3.24	1.08–9.69	0.035
(multivariate analysis)	1.675 (0.692)	5.34	1.37–20.73	0.016
Cholesterol	−0.010 (0.004)	0.991	0.983–0.998	0.017
Triglyceride	−0.006 (0.003)	0.994	0.989–0.999	0.019
LDL	−0.010 (0.005)	0.990	0.982–0.999	0.034

Note: *The bolded values relate to the multivariate analysis.

Abbreviations: Hb, hemoglobin; PLT, platelet; MI, myocardial infarction; LDL, low density lipoprotein.

Table 4 Correlation of Sum ST Elevation/Depression Resolution or in the Lead with Maximum ST Deviation in the Presenting ECG with Outcomes of in-Hospital Acute Heart Failure, in-Hospital Death, Major Adverse Cardiac Events, and Death in Follow-Up

	In-Hospital Acute Heart Failure		In-Hospital Death		MACE		Death during Follow-Up
	χ^2	p	χ^2	p	χ^2	p	χ^2	p
∑ST elevation resolution	0.36	0.84	25.09	<0.0001*	3.19	0.20	1.82	0.77
∑ST depression resolution	7.4	0.025	3.27	0.19	8.84	0.012	5.7	0.22
ST elevation resolution in lead with max ST elevation in presenting ECG	0.26	0.88	24.5	<0.0001	2.88	0.24	3.29	0.51
ST depression resolution in lead with max ST depression in presenting ECG	6.42	0.04	8.45	0.015	7.88	0.019	4.17	0.38

Note: *Significant correlations are in italic form for better interpretation.

Abbreviations: MACE, major adverse cardiac events; ECG, electrocardiogram.

Figure 1 (A) Area under the curve for major adverse cardiac events in association with resolution of sigma ST depression or elevation resolution. (B) Area under the curve (AUC) for ROC curve of in-hospital mortality in relation to Sigma STD/STE resolution.

Figure 2 (A) Area under the curve for major adverse cardiac events in relation to resolution of ST depression or elevation in a single lead with maximum ST deviation in presenting electrocardiogram. (B) Area under the curve (AUC) for ROC curve of in-hospital mortality in relation to STD/STE resolution in a single lead with maximum ST deviation in presenting electrocardiogram.

Figure 3 (A) Survival curve in two groups: 1- Sigma ST elevation resolution ≥50%, 2- <50%. In this curve the horizontal line is follow-up time in month(s) and the vertical line is survival based on cumulative survival. (B) Survival curve in two groups: 1- Sigma ST depression resolution ≥50%, and 2- <50%. In this curve the horizontal line is follow-up time in month(s) and the vertical line is survival based on cumulative logarithm.