Muhammad Tariq Farman, Abdul Malik, Qurban Ali Rahu, Jawaid Akbar Sial, Naveedullah Khan, Waheed Murad Shaikh, Tahir Saghir, Khan Shah Zaman.
Outcome of primary percutaneous coronary intervention with early and late ST resolution - earlier is better!.
Pak Heart J Jan ;48(1):42-7.

Objective: To compare the outcome of Primary PCI in patients presenting with early ST resolution versus those presenting late ST resolution after the procedure. Methodology: This observational prospective study was conducted in the Catheterization Laboratory of a Tertiary Care Cardiovascular Centre of Pakistan.Those patients who under went primary PCI were enrolled. All patients were pretreated with Aspirin 300 mg, and Clopidogrel 600mg. Platelet glycoprotein IIb IIIa inhibitor was given in the Catheterization Laboratory before the commencement of procedure. Primary PCI was done in a standard fashion. Procedural details,angiographic and electrocardiographic signs were recorded after PCI and clinical follow up was documented up to 1 year. Results: A total of 150 consecutive patients underwent primary PCI. 112 patients showed ST resolution within 60 minutes while 38 patients showed ST resolution after 60 minutes. Patients with early ST resolution showed significant procedural success (100 % vs. 94.7 %; P=0.014), and stable follow up at 30 days (92 % vs.50 %; P= <0.001) and one year (88.3 % vs. 60.6 %; P=< 0.001). Mortality at 30 days was significantly lower (0.9% vs. 7.9 %; P=0.019) in patients with early ST resolution while coronary artery bypass surgery was also significantly lower at 30 days (1.7 % vs. 15.8 %; P=0.001) and one year (2.7 % vs. 15.8 %;P=0.004). Patients with late ST resolution were significantly aged (54.5+-8.1 vs.50.4+-12.9; P=0.023), more diabetic (39.5 % vs. 19.6 %; P=0.014), having longer (>120 minutes) chest pain to ER time (34.2 % vs. 17.9%; P=0.03), and having diffusely diseased vessels (73.7% vs. 52.7%; P=0.023). Three vessel disease was also more frequently seen in patients with late ST resolution (36.9%vs. 17.9%; P=0.015). Conclusion: Outcome of patients showing early ST resolution is significantly better than those showing late ST resolution. Elderly, diabetes, longer chest pain to ER time and diffuse three vessel disease are associated with late ST resolution.

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