Spitaleri G, et al. - The impact of ST-segment resolution (STR) on very long-term outcomes of primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) among participants of the EXAMINATION trial was assessed. Researchers found that the evaluation of 70% STR post-pPCI offered prognostic information at 5-year follow-up in STEMI patients. Moreover, it could be used to detect patients at high risk of very long-term cardiovascular events.

• According to the presence of STR < 50% and STR < 70% at the 30-minute post-pPCI ECG, study participants were stratified.
• Patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction or any revascularization at 5-year follow-up was the primary endpoint.

• Data showed that both baseline and post-PCI 30-minute ECGs were available for STR assessment in 1351 patients.
• Out of these, STR < 50% and STR < 70% was shown by a total of 228 (16.9%) and 500 (37.0%) patients, respectively.
• Findings demonstrated that the patient-oriented combined was observed more frequently in patients with STR < 50% (hazard ratio [HR] 1.156; 95% CI 1.194–2.027; p<0.001) and in patients with STR < 70% (HR 1.460; 95% CI 1.169–1.824; p<0.001), as compared to patients with STR ≥ 50% and STR ≥ 70%, respectively, at 5-year follow-up.
• A significant increase in the rate of all-cause death and any revascularization were recognized as the main drivers of this difference in both cases.
• Additionally, researchers noted that STR < 70%, but not STR < 50%, resulted as a 5-year independent predictor of POCE (adjusted HR: 1.338, 95% CI: 1.008 –1.778, p=0.044) after multivariable adjustment.