ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality worldwide. Simple electrocardiogram (ECG) tools, including ST-segment resolution (STR) have been developed to identify high-risk STEMI patients after primary percutaneous coronary intervention (PCI). We evaluated the prognostic impact of STR in the ECG lead with maximal baseline ST-segment elevation (STE) 30-60 minutes after primary PCI in 7,654 STEMI patients included in the TOTAL trial. Incomplete or no STR was defined as < 70% STR and complete STR as ≥ 70% STR. The primary outcome was the composite of cardiovascular death, recurrent myocardial infarction (MI), cardiogenic shock, or new or worsening New York Heart Association (NYHA) class IV heart failure at 1-year follow-up. Of 7,654 patients, 42.9% had incomplete or no STR and 57.1% had complete STR. The primary outcome occurred in 341 patients (10.4%) in the incomplete or no STR group and in 234 patients (5.4%) in the complete STR group. In Cox regression analysis, adjusted hazard ratio for STR < 70% to predict the primary outcome was 1.56 (95% confidence interval 1.32-1.89; < .001) (model adjusted for all baseline comorbidities, clinical status during hospitalization, angiographic findings, and procedural techniques). In a large international study of STEMI patients, STR < 70% 30-60 minutes post primary PCI in the ECG lead with the greatest STE at admission was associated with an increased rate of the composite of cardiovascular death, recurrent MI, cardiogenic shock, or new or worsening NYHA class IV heart failure at 1-year follow-up. Clinicians should pay attention to this simple ECG finding.

中文翻译：

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单导联 ST 段消退对接受直接 PCI 治疗的 ST 段抬高型心肌梗死患者的预后意义 – 随机 TOTAL 试验的子研究

ST 段抬高型心肌梗死 (STEMI) 与全世界的高发病率和死亡率相关。包括 ST 段解析 (STR) 在内的简单心电图 (ECG) 工具已被开发用于识别初次经皮冠状动脉介入治疗 (PCI) 后的高危 STEMI 患者。我们对 TOTAL 试验中纳入的 7,654 名 STEMI 患者进行了直接 PCI 后 30-60 分钟最大基线 ST 段抬高 (STE) 的 ECG 导联中 STR 的预后影响评估。不完整或无 STR 定义为 < 70% STR，完整 STR 定义为 ≥ 70% STR。主要结局是一年随访时心血管死亡、复发性心肌梗死 (MI)、心源性休克或新发或恶化的纽约心脏协会 (NYHA) IV 级心力衰竭的复合结局。在 7,654 名患者中，42.9% 的 STR 不完整或没有，57.1% 的 STR 完整。主要结局发生在不完整或无 STR 组的 341 名患者（10.4%）和完整 STR 组的 234 名患者（5.4%）。在 Cox 回归分析中，预测主要结局的 STR < 70% 的调整后风险比为 1.56（95% 置信区间 1.32-1.89；< .001）（模型根据所有基线合并症、住院期间的临床状态、血管造影结果和程序技术）。在一项针对 STEMI 患者的大型国际研究中，入院时具有最大 STE 的心电图导联在初次 PCI 后 30-60 分钟 STR < 70% 与心血管死亡、复发性 MI、心源性休克或心源性休克的复合发生率增加相关。一年随访时出现新发或恶化的 NYHA IV 级心力衰竭。临床医生应该注意这个简单的心电图发现。