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Right atrial thrombus in patients with hemodialysis central venous catheters
e6
Abstracts / Cardiovascular Revascularization Medicine 13 (2012) e3–e19
of 19.9±14.3 mm and an estimate time of occlusion of 47.4± 62 months. The only independent predictor angiographic factor of failure was a severe (N90°) curve between the CTO lesion and the proximal vessel (OR = 3.308 (CI 95% 1.121–9.765). The MCT analysis revealed as the only predictor factor of failure an arch of calcium in the proximal (P = .048) and middle (P = .037) segment of the occlusion that affected more than 50% of the vessel circumference. Conclusions: Our study of PCI of CTO lesions, analyzed previously with MCT as guidance for failure factors showed the presence of calcium in the proximal and middle segments of the body of the occlusion that affected more than 50% of the circumference of the vessel. The only independent predictor of failure in the analysis of angiographic factors was the presence of a severe curve that can increase trice the rate of failure.
doi:10.1016/j.carrev.2012.01.018
Emergent versus elective percutaneous stent implantation in the unprotected left main: long-term outcomes from a single center registry Victoria Martin-Yustea, Luis R. Alvarez-Contrerasa, Salvatore Brugalettaa, Clarissa Colab, Vicens Martic, Joan Garcia-Picartc, Manel Sabatea a Hospital Clinic de Barcelona, Barcelona, Spain b Hospital del Mar, Barcelona, Spain c Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Background: Unprotected left main (ULM) coronary disease is considered by contemporary guidelines as a Class I indication for surgery. However, percutaneous coronary intervention (PCI) is often carried out in the ULM in either emergent or in high risk elective procedures. The aim of this study was to evaluate ULM-PCI as a feasible and safe procedure in the emergent setting, and to analyze outcomes in both scenarios. Methods: Angiographic and clinical data were collected retrospectively for all patients who underwent emergent or elective PCI on ULM at our center from January 2006 to June 2009. All patients were followed up with a clinical visit or telephone interview. Main outcomes included major adverse cardiac events (MACE) and its individual components: cardiac death, myocardial infarction (MI), and target lesion revascularization. These were analyzed at the longest follow-up available. Results: A total of 98 consecutive patients with significant LM disease were included. Fifty-seven of them were treated as a planned procedure (Elective group) and 41 as an emergent procedure (Emergent group). Procedural success was achieved in a 100% of cases in the elective group and in 88% in the emergent group (P = .011). Higher use of a drug-eluting stent was recorded in the elective group (75% vs 45%, P b.002). The emergent group presented a higher in-hospital mortality (24% vs 2%, P b.001). At a mean follow-up of 626 ± 380 days, the overall MACE rate was similar between the two groups (Emergent group 23% vs. Elective group 17%: P = .52). Independent predictors of MACE after discharge follow-up were post-procedure minimal diameter and DES use. Conclusions: Emergent PCI of the ULM exhibits worse in-hospital outcomes as compared to elective procedures. However, after discharge, long-term outcomes remain comparably good between groups.
doi:10.1016/j.carrev.2012.01.019
Safety and one-year revascularization outcomes of Silverhawk atherectomy in treating in-stent restenosis of femoropopliteal arteries: a retrospective review from a single center Nicolas W. Shammas, Gail A. Shammas, Timothy J. Helou, Cara M. Voelliger, Luay Mrad, Michael Jerin Midwest Cardiovascular Research Foundation, Davenport, IA, USA Background: Treatment of in-stent restenosis of the femoropopliteal vessels with balloon angioplasty carries a high rate of recurrence and repeat stenting. Silverhawk atherectomy (SA) has a theoretical advantage of reducing the volume of restenotic tissue and delaying the need for repeat revascularization and stenting. We present a retrospective analysis from our center on the use of SA in treating in-stent restenosis and report on its safety and rates of one-year target lesion revascularization (TLR) and target vessel revascularization (TVR). Methods: Demographic, clinical, angiographic, and procedural data were collected on all patients that underwent SA for in-stent restenosis from January 2005 until June 2010. Major adverse events and one-year TLR and TVR were obtained by the review of medical records. Descriptive analysis was performed on all variables. Results: Forty-one consecutive patients (mean age 70.9 ± 9.2 years, 56% males) were included and followed for a mean of 331.63 days. The following variables are noted: mean ankle brachial index (ABI) of treated leg 0.66 ± 0.2, chronic renal failure (creatinine N2.0 at baseline) 14.6%, diabetes 61%, history of smoking 85.4%, number of runoff vessels of treated limb 1.9 ± 0.9, hypertension 90.2%, lesion length 126.2 ± 79.3 mm, lesion severity 90.7% ± 8.2%, vessel diameter 5.8 ± 0.7 mm. All patients received bivalirudin during the procedure and were on aspirin and clopidogrel. Adjunctive balloon angioplasty was performed in 97.6% at a mean pressure of 11.9 ± 3.3 atm. Embolic filter protection (EFP) was used in 56.1% of patients. Bailout stenting was 24.4%. Angiographic acute procedural success (b30% residual narrowing) occurred in 100% of patients. Compared to baseline, ABI at one month significantly improved to 0.91 ± 0.19 (P b.05) but was not statistically different at one year (0.61 ± 0.28). In 81.9% of filters debris was noted. The following adverse events were reported: distal embolization (DE) requiring treatment 7.3%, stent thrombosis 4.9%, planned minor amputation in the non index limb 2.4%. No device malfunction or device related complications occurred. Also, there was no procedure related death or amputation. TLR and TVR occurred in 31.7% and 34.1%, respectively. Conclusion: SA has favorable results in treating in-stent restenosis with acceptable low adverse events and one year TLR/TVR. DE does occur significantly with SA and EFP appears to be effective in capturing this debris.
doi:10.1016/j.carrev.2012.01.020
Right atrial thrombus in patients with hemodialysis central venous catheters Mushabab Al Murayeh, Adel Al Masswary, Mohamed Moselhy, Khalid Al Sheikh, Ali Y. Moustafa Armed Forces Hospital, Southern Region, Khamis Mushayt, Saudi Arabia Aims: Data regarding right atrial thrombus (RAT) in patients with prolonged use of hemodialysis central venous catheters are scarce. We studied the clinical and echocardiographic findings and the management of CVC-RAT. Methods: We screened 43 and 50 patients with CVC in two consecutive years. Screening was made using transthoracic echocardiography (TTE) every 6 months or whenever clinically indicated.
Abstracts / Cardiovascular Revascularization Medicine 13 (2012) e3–e19
Transesophageal echocardiography (TEE) was performed whenever indicated after TTE, and whenever a mass is seen. Results: Right atrial thrombus was found in 8 patients. The mean duration of hemodialysis was 2.5 years. The mean time from CVC insertion was 12.5 months (minimum 2 months and maximum 18 months). Fever and positive blood culture were found in 5 patients each year. Thrombi were mural with limited mobility and globular appearance (mean size was 1.8 × 3.5 cm) in 5 patients and had a highly mobile serpentine appearance (mean length of 5.3 cm) in 3 patients. Mild and moderate obstruction to the diastolic tricuspid flow was documented in 3 and 2 patients respectively. Surgery was needed in 5 patients, with CVC removed followed by anticoagulation in 3 patients. None of these patients had endocarditis, 4 patients had pulmonary hypertension; however no death was reported. Conclusion: This series reports a high incidence of RAT in patients with prolonged use of CVC as hemodialysis access. Routine screening by echocardiography was of great value in the diagnosis and management.
doi:10.1016/j.carrev.2012.01.021
Safety and feasibility of transradial balloon angioplasty of brachio-axillary hemodialysis access grafts Ali Y. Moustafaa, Yung-Lung Chenb, Cheng-I Chengb, Chien-Jen Chenb, Shyh-Ming Chenb, Yuan-Kai Hsiehb, Chih-Yuan Fangb, Chiung-Jen Wub, Cheng-Hsu Yangb a Suez Canal University Hospital, Ismailia, Egypt b Chang Gung Memorial Hospital, Kaohsiung, Taiwan Background: Percutaneous balloon angioplasty (PTA) of dysfunctional brachio-axillary hemodialysis grafts (BAHG) is routinely approached by brachial artery or graft puncture; both have limitations and potential complications. We report, a previously unreported, experience of routine transradial approach (TRA) for PTA of BAHG. Material and Methods: We prospectively enrolled 36 consecutive patients with dysfunctional BAHG from January 2003 to January 2007. Technical (b50% residual stenosis) and clinical (at least one full hemodialysis session) success was reported. Included are all procedures, whenever TRA was attempted, as intention-to-treat analysis. Results: Technical and clinical success was 85.7% and 88.9% respectively. The radial artery was successfully accessed in 98.4% of procedures. 77.8% of grafts were totally occluded, and 9.5% had no stump. One patient had PTA for concomitant central vein stenosis. The primary patency rate at 3, 6, 9, and 12 months was 76% (38/50), 56% (28/50), 35.42% (17/48), and 31.91% (15/47) respectively. Primary assisted patency at 3, 6, 9, and 12 months was 88% (44/50), 84% (42/50), 83.33% (40/48), and 80.85% (38/47) respectively. One patient had transradial PTA for a concomitant central vein stenosis. Complications included extravasations, radial artery dissection, and venous rupture each in one (1.6%) procedure, and residual dissection in 2 procedures (3.28%). No patients had distal embolization, hand ischemia, or symptomatic pulmonary embolism. Conclusion: Transradial PTA of BAHG is feasible with high success. It provides a safer alternative to other approaches.
doi:10.1016/j.carrev.2012.01.022
Single transradial catheter for right and left coronary diagnosis and intervention Ali Y. Moustafaa, Yan-Kai Hsiehb, Cheng-I Chengb, Chiung-Jen Wub a Suez Canal University Hospital, Ismailia, Egypt b Chang Gung Memorial Hospital, Kaohsiung, Taiwan
e7
Aims: There are no data about the utilization of a single transradial guiding catheter for the current routine, transradial, right and left coronary diagnosis, and intervention. We investigated the feasibility and safety of using 6 Fr Ikari left (3.5) guiding catheter for this purpose. Methods and Results: This prospective single-center study enrolled 621 consecutive patients referred for transradial coronary diagnosis with ad hoc coronary intervention. The radial artery was successfully accessed in 96.8% of patients. Right and left coronary arteries were successfully engaged in 98.1% of cases. Engagement with good back-up at the right and left coronaries (device success) was achieved in 96.6% of cases. Coronary intervention was performed in 61.2% of cases, among them, 84.5% had coronary stenting. Procedure success was 98.2%. Procedure time was 21.4 ± 15.1 and 65.4 ± 36.1 min; mean fluoroscopy time was 6.8 ± 7.2 and 24.1 ± 18.9 min and the mean contrast volume was 96.2 ± 45.3 and 197.9 ± 46.2 ml for diagnostic and interventional cases respectively. One patient (0.16%) had catheter related radial artery spasm and 3 patients (0.48%) encountered a catheter induced RCA dissection. Conclusion: Right and left coronary angiography and intervention are feasible and highly successful using IK 3.5 as a single transradial guiding catheter.
doi:10.1016/j.carrev.2012.01.023
Prognostic significance of reciprocal ST segment depression resolution in patients with acute ST elevation myocardial infarction Anand Deshmukh, Paul Turner, Suman Pasupuleti, Priscilla Hoang, Aiman Smer, Ojas Bansal, Luke Hvaas, Michael White, Claire Hunter, Aryan Mooss, Dennis Esterbrooks The Cardiac Center of Creighton University, Omaha, NE, USA Background: There is conflicting evidence regarding the prognostic significance of resolution of reciprocal ST segment depression (RSTD) in patients with ST elevation myocardial infarction (STEMI). Objectives: We conducted a retrospective study to evaluate the prognostic significance of resolution of RSTD after percutaneous coronary intervention (PCI) in patients with STEMI. Methods: All patients with STEMI that were treated with PCI from January 2003 through May 2010 at our institute were included in the study. We collected demographic, clinical, electrocardiographic, and procedural characteristics in these patients. Resolution of RSTD was compared between the ECGs prior to and after PCI and patients were stratified into two groups. Group 1 consisted of patients with N50% RSTD resolution, group 2 consisted of b50% RSTD resolution. Patients with no available ECGs or no RSTD at presentation and patients with failed PCI were excluded from the analysis. Primary endpoint was one-year composite end-point of major adverse cardiac events (MACE), which consisted of all cause mortality, recurrent acute coronary syndrome, and stroke/transient ischemic attack (TIA). Secondary end points were in-hospital ventricular tachycardia (VT), ventricular fibrillation (VFib), cardiogenic shock (CS), and requirement for temporary or permanent pacemakers. Results: A total of 260 patients qualified for the study of which 228 (87.7%) had N50% RSTD resolution (group 1) and 32 (12.3%) had b50% RSTD resolution (group 2). After controlling for baseline differences in demographic, clinical, and procedural characteristics between the two groups, the primary end point occurred in 21.2% of patients in group 1 and 22.2% of patients in group 2 (P = .56). There were no significant differences between the two groups in regards to VT (5.7% in group 1 vs. 9.4% in group 2; P = .05), VFib (12.8% in group 1 vs. 9.4% in group 2; P = .12), CS (8.4% in group 1 vs. 21.9% in group 2; P = .92), or temporary/
Abstracts / Cardiovascular Revascularization Medicine 13 (2012) e3–e19
of 19.9±14.3 mm and an estimate time of occlusion of 47.4± 62 months. The only independent predictor angiographic factor of failure was a severe (N90°) curve between the CTO lesion and the proximal vessel (OR = 3.308 (CI 95% 1.121–9.765). The MCT analysis revealed as the only predictor factor of failure an arch of calcium in the proximal (P = .048) and middle (P = .037) segment of the occlusion that affected more than 50% of the vessel circumference. Conclusions: Our study of PCI of CTO lesions, analyzed previously with MCT as guidance for failure factors showed the presence of calcium in the proximal and middle segments of the body of the occlusion that affected more than 50% of the circumference of the vessel. The only independent predictor of failure in the analysis of angiographic factors was the presence of a severe curve that can increase trice the rate of failure.
doi:10.1016/j.carrev.2012.01.018
Emergent versus elective percutaneous stent implantation in the unprotected left main: long-term outcomes from a single center registry Victoria Martin-Yustea, Luis R. Alvarez-Contrerasa, Salvatore Brugalettaa, Clarissa Colab, Vicens Martic, Joan Garcia-Picartc, Manel Sabatea a Hospital Clinic de Barcelona, Barcelona, Spain b Hospital del Mar, Barcelona, Spain c Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Background: Unprotected left main (ULM) coronary disease is considered by contemporary guidelines as a Class I indication for surgery. However, percutaneous coronary intervention (PCI) is often carried out in the ULM in either emergent or in high risk elective procedures. The aim of this study was to evaluate ULM-PCI as a feasible and safe procedure in the emergent setting, and to analyze outcomes in both scenarios. Methods: Angiographic and clinical data were collected retrospectively for all patients who underwent emergent or elective PCI on ULM at our center from January 2006 to June 2009. All patients were followed up with a clinical visit or telephone interview. Main outcomes included major adverse cardiac events (MACE) and its individual components: cardiac death, myocardial infarction (MI), and target lesion revascularization. These were analyzed at the longest follow-up available. Results: A total of 98 consecutive patients with significant LM disease were included. Fifty-seven of them were treated as a planned procedure (Elective group) and 41 as an emergent procedure (Emergent group). Procedural success was achieved in a 100% of cases in the elective group and in 88% in the emergent group (P = .011). Higher use of a drug-eluting stent was recorded in the elective group (75% vs 45%, P b.002). The emergent group presented a higher in-hospital mortality (24% vs 2%, P b.001). At a mean follow-up of 626 ± 380 days, the overall MACE rate was similar between the two groups (Emergent group 23% vs. Elective group 17%: P = .52). Independent predictors of MACE after discharge follow-up were post-procedure minimal diameter and DES use. Conclusions: Emergent PCI of the ULM exhibits worse in-hospital outcomes as compared to elective procedures. However, after discharge, long-term outcomes remain comparably good between groups.
doi:10.1016/j.carrev.2012.01.019
Safety and one-year revascularization outcomes of Silverhawk atherectomy in treating in-stent restenosis of femoropopliteal arteries: a retrospective review from a single center Nicolas W. Shammas, Gail A. Shammas, Timothy J. Helou, Cara M. Voelliger, Luay Mrad, Michael Jerin Midwest Cardiovascular Research Foundation, Davenport, IA, USA Background: Treatment of in-stent restenosis of the femoropopliteal vessels with balloon angioplasty carries a high rate of recurrence and repeat stenting. Silverhawk atherectomy (SA) has a theoretical advantage of reducing the volume of restenotic tissue and delaying the need for repeat revascularization and stenting. We present a retrospective analysis from our center on the use of SA in treating in-stent restenosis and report on its safety and rates of one-year target lesion revascularization (TLR) and target vessel revascularization (TVR). Methods: Demographic, clinical, angiographic, and procedural data were collected on all patients that underwent SA for in-stent restenosis from January 2005 until June 2010. Major adverse events and one-year TLR and TVR were obtained by the review of medical records. Descriptive analysis was performed on all variables. Results: Forty-one consecutive patients (mean age 70.9 ± 9.2 years, 56% males) were included and followed for a mean of 331.63 days. The following variables are noted: mean ankle brachial index (ABI) of treated leg 0.66 ± 0.2, chronic renal failure (creatinine N2.0 at baseline) 14.6%, diabetes 61%, history of smoking 85.4%, number of runoff vessels of treated limb 1.9 ± 0.9, hypertension 90.2%, lesion length 126.2 ± 79.3 mm, lesion severity 90.7% ± 8.2%, vessel diameter 5.8 ± 0.7 mm. All patients received bivalirudin during the procedure and were on aspirin and clopidogrel. Adjunctive balloon angioplasty was performed in 97.6% at a mean pressure of 11.9 ± 3.3 atm. Embolic filter protection (EFP) was used in 56.1% of patients. Bailout stenting was 24.4%. Angiographic acute procedural success (b30% residual narrowing) occurred in 100% of patients. Compared to baseline, ABI at one month significantly improved to 0.91 ± 0.19 (P b.05) but was not statistically different at one year (0.61 ± 0.28). In 81.9% of filters debris was noted. The following adverse events were reported: distal embolization (DE) requiring treatment 7.3%, stent thrombosis 4.9%, planned minor amputation in the non index limb 2.4%. No device malfunction or device related complications occurred. Also, there was no procedure related death or amputation. TLR and TVR occurred in 31.7% and 34.1%, respectively. Conclusion: SA has favorable results in treating in-stent restenosis with acceptable low adverse events and one year TLR/TVR. DE does occur significantly with SA and EFP appears to be effective in capturing this debris.
doi:10.1016/j.carrev.2012.01.020
Right atrial thrombus in patients with hemodialysis central venous catheters Mushabab Al Murayeh, Adel Al Masswary, Mohamed Moselhy, Khalid Al Sheikh, Ali Y. Moustafa Armed Forces Hospital, Southern Region, Khamis Mushayt, Saudi Arabia Aims: Data regarding right atrial thrombus (RAT) in patients with prolonged use of hemodialysis central venous catheters are scarce. We studied the clinical and echocardiographic findings and the management of CVC-RAT. Methods: We screened 43 and 50 patients with CVC in two consecutive years. Screening was made using transthoracic echocardiography (TTE) every 6 months or whenever clinically indicated.
Abstracts / Cardiovascular Revascularization Medicine 13 (2012) e3–e19
Transesophageal echocardiography (TEE) was performed whenever indicated after TTE, and whenever a mass is seen. Results: Right atrial thrombus was found in 8 patients. The mean duration of hemodialysis was 2.5 years. The mean time from CVC insertion was 12.5 months (minimum 2 months and maximum 18 months). Fever and positive blood culture were found in 5 patients each year. Thrombi were mural with limited mobility and globular appearance (mean size was 1.8 × 3.5 cm) in 5 patients and had a highly mobile serpentine appearance (mean length of 5.3 cm) in 3 patients. Mild and moderate obstruction to the diastolic tricuspid flow was documented in 3 and 2 patients respectively. Surgery was needed in 5 patients, with CVC removed followed by anticoagulation in 3 patients. None of these patients had endocarditis, 4 patients had pulmonary hypertension; however no death was reported. Conclusion: This series reports a high incidence of RAT in patients with prolonged use of CVC as hemodialysis access. Routine screening by echocardiography was of great value in the diagnosis and management.
doi:10.1016/j.carrev.2012.01.021
Safety and feasibility of transradial balloon angioplasty of brachio-axillary hemodialysis access grafts Ali Y. Moustafaa, Yung-Lung Chenb, Cheng-I Chengb, Chien-Jen Chenb, Shyh-Ming Chenb, Yuan-Kai Hsiehb, Chih-Yuan Fangb, Chiung-Jen Wub, Cheng-Hsu Yangb a Suez Canal University Hospital, Ismailia, Egypt b Chang Gung Memorial Hospital, Kaohsiung, Taiwan Background: Percutaneous balloon angioplasty (PTA) of dysfunctional brachio-axillary hemodialysis grafts (BAHG) is routinely approached by brachial artery or graft puncture; both have limitations and potential complications. We report, a previously unreported, experience of routine transradial approach (TRA) for PTA of BAHG. Material and Methods: We prospectively enrolled 36 consecutive patients with dysfunctional BAHG from January 2003 to January 2007. Technical (b50% residual stenosis) and clinical (at least one full hemodialysis session) success was reported. Included are all procedures, whenever TRA was attempted, as intention-to-treat analysis. Results: Technical and clinical success was 85.7% and 88.9% respectively. The radial artery was successfully accessed in 98.4% of procedures. 77.8% of grafts were totally occluded, and 9.5% had no stump. One patient had PTA for concomitant central vein stenosis. The primary patency rate at 3, 6, 9, and 12 months was 76% (38/50), 56% (28/50), 35.42% (17/48), and 31.91% (15/47) respectively. Primary assisted patency at 3, 6, 9, and 12 months was 88% (44/50), 84% (42/50), 83.33% (40/48), and 80.85% (38/47) respectively. One patient had transradial PTA for a concomitant central vein stenosis. Complications included extravasations, radial artery dissection, and venous rupture each in one (1.6%) procedure, and residual dissection in 2 procedures (3.28%). No patients had distal embolization, hand ischemia, or symptomatic pulmonary embolism. Conclusion: Transradial PTA of BAHG is feasible with high success. It provides a safer alternative to other approaches.
doi:10.1016/j.carrev.2012.01.022
Single transradial catheter for right and left coronary diagnosis and intervention Ali Y. Moustafaa, Yan-Kai Hsiehb, Cheng-I Chengb, Chiung-Jen Wub a Suez Canal University Hospital, Ismailia, Egypt b Chang Gung Memorial Hospital, Kaohsiung, Taiwan
e7
Aims: There are no data about the utilization of a single transradial guiding catheter for the current routine, transradial, right and left coronary diagnosis, and intervention. We investigated the feasibility and safety of using 6 Fr Ikari left (3.5) guiding catheter for this purpose. Methods and Results: This prospective single-center study enrolled 621 consecutive patients referred for transradial coronary diagnosis with ad hoc coronary intervention. The radial artery was successfully accessed in 96.8% of patients. Right and left coronary arteries were successfully engaged in 98.1% of cases. Engagement with good back-up at the right and left coronaries (device success) was achieved in 96.6% of cases. Coronary intervention was performed in 61.2% of cases, among them, 84.5% had coronary stenting. Procedure success was 98.2%. Procedure time was 21.4 ± 15.1 and 65.4 ± 36.1 min; mean fluoroscopy time was 6.8 ± 7.2 and 24.1 ± 18.9 min and the mean contrast volume was 96.2 ± 45.3 and 197.9 ± 46.2 ml for diagnostic and interventional cases respectively. One patient (0.16%) had catheter related radial artery spasm and 3 patients (0.48%) encountered a catheter induced RCA dissection. Conclusion: Right and left coronary angiography and intervention are feasible and highly successful using IK 3.5 as a single transradial guiding catheter.
doi:10.1016/j.carrev.2012.01.023
Prognostic significance of reciprocal ST segment depression resolution in patients with acute ST elevation myocardial infarction Anand Deshmukh, Paul Turner, Suman Pasupuleti, Priscilla Hoang, Aiman Smer, Ojas Bansal, Luke Hvaas, Michael White, Claire Hunter, Aryan Mooss, Dennis Esterbrooks The Cardiac Center of Creighton University, Omaha, NE, USA Background: There is conflicting evidence regarding the prognostic significance of resolution of reciprocal ST segment depression (RSTD) in patients with ST elevation myocardial infarction (STEMI). Objectives: We conducted a retrospective study to evaluate the prognostic significance of resolution of RSTD after percutaneous coronary intervention (PCI) in patients with STEMI. Methods: All patients with STEMI that were treated with PCI from January 2003 through May 2010 at our institute were included in the study. We collected demographic, clinical, electrocardiographic, and procedural characteristics in these patients. Resolution of RSTD was compared between the ECGs prior to and after PCI and patients were stratified into two groups. Group 1 consisted of patients with N50% RSTD resolution, group 2 consisted of b50% RSTD resolution. Patients with no available ECGs or no RSTD at presentation and patients with failed PCI were excluded from the analysis. Primary endpoint was one-year composite end-point of major adverse cardiac events (MACE), which consisted of all cause mortality, recurrent acute coronary syndrome, and stroke/transient ischemic attack (TIA). Secondary end points were in-hospital ventricular tachycardia (VT), ventricular fibrillation (VFib), cardiogenic shock (CS), and requirement for temporary or permanent pacemakers. Results: A total of 260 patients qualified for the study of which 228 (87.7%) had N50% RSTD resolution (group 1) and 32 (12.3%) had b50% RSTD resolution (group 2). After controlling for baseline differences in demographic, clinical, and procedural characteristics between the two groups, the primary end point occurred in 21.2% of patients in group 1 and 22.2% of patients in group 2 (P = .56). There were no significant differences between the two groups in regards to VT (5.7% in group 1 vs. 9.4% in group 2; P = .05), VFib (12.8% in group 1 vs. 9.4% in group 2; P = .12), CS (8.4% in group 1 vs. 21.9% in group 2; P = .92), or temporary/