J.K. French*, J. Andrews, S.O.M. Manda, R.A.H. Stewart, J.J.C. M^cTigue, H.D. White.

Green Lane Hospital, Auckland, New Zealand

Early resolution of ST segment elevation is associated with improved short-term outcome after acute myocardial infarction. However, the influence of ST segment resolution on long-term outcome, particularly with respect to infarct-artery Thrombolysis In Myocardial Infarction (TIMI) flow grades, is not known.

The study consisted of 859 patients with technically suitable electrocardiograms (ECG) from 3 trials of thrombolytic and adjunctive therapies. ST segment resolution, and the presence of T wave changes, on the baseline and post-thrombolytic therapy ECG's were evaluated at a median of 167 [IQR 90, 232] minutes. TIMI flow grades were assessed at 3 weeks and vital status was determined at a median of 6.25 [IQR 5.0, 8.4] years. Absence of early 50% ST segment resolution independently predicted an increased risk of late death (P<0.001), late cardiac death (P=0.004) and failure to achieve long-term event free survival (P=0.003) in all patients. In patients with TIMI 2 or 3 flow, late death (P=0.003) and failure to achieve long-term event free survival (P=0.008) occurred more frequently in patients who failed to achieve early ST segment resolution. In patients with TIMI 0-1 flow, ST segment resolution was associated with improved late survival, compared to those without ST segment resolution (P=0.04). Other ECG predictors of late mortality were the amount of baseline ST elevation (P=0.001) and, in patients with an occluded artery, the presence of peaked T waves on the baseline ECG (P=0.02).

In conclusion, failure to achieve early 50% ST segment resolution of maximal ST elevation was the most consistent ECG predictor of an adverse long-term outcome. This electrocardiographic parameter predicts higher risk patients who may require more aggressive management.

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