THE USE OF PRIMARY PCI STRATEGY FOR ST-DEPRESSION ACUTE MYOCARDIAL INFARCTION

Background: The aim of this study was to test the hypothesis that all ST-depression acute myocardial infarctions represent an emergency similar to STEMI, requiring ultrafast transfer to PCI center followed by coronary angiography and reperfusion.

Methods: A total of 6742 consecutive patients with acute myocardial infarction was admitted to five participating hospitals, retrospectively analyzed and divided into the following subgroups: STE-MI (n =3447), STD-MI (n =907), LBBB-MI (n =291), RBBB-MI (n= 427), other ECG MI (n =1670). Baseline characteristics and coronary angiographic data were studied. Reperfusion therapies used and in-hospital mortality were analyzed.

Results: Patients with ST-depression MI were significantly older than STEMI, had more frequently diabetes and previous myocardial infarction (p<0.001). STDMI patients had more extensive coronary atherosclerosis than patients with STEMI (p<0.001). Left main and left circumflex were more frequently IRA in STDMI patients (<0.001). Complete coronary occlusion was less frequent among STDMI vs. STEMI (p<0.001). PCI was performed in 88.1% of STEMI vs. 61.8% STDMI patients, the PCI success rates were similarly high. Despite the higher ejection fraction, in-hospital mortality was comparable between STDMI and. STEMI (p=0.330).
Conclusion: ST-depression AMI represent an emergency similar to ST-elevation AMI with the same need for emergent coronary angiography and pPCI when appropriate. Thus, in the current “post-thrombolytic” era, the classification of AMI should be considered, putting all ST-segment shifts (elevation + depressions) together as a single group requesting direct transfer to PCI center.