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Abstract

Introduction: ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular emergency requiring prompt reperfusion therapy. Primary percutaneous coronary intervention (PPCI) is the preferred strategy, yet angiographic success alone may not reflect adequate myocardial reperfusion. ST-segment resolution (STR) on electrocardiography serves as a reliable marker of microvascular recovery and a predictor of patient outcomes. Objective: To assess the speed and magnitude of ST-segment resolution during and after PPCI in STEMI patients, whether its timing relates to in-hospital outcomes, and to determine predictors of incomplete STR. Methodology: This retrospective cohort study was carried out at National Institute of Cardiovascular disease (NICVD) and its satellite centers between June 2023 and May 2024. The statistics of 180 STEMI patients who received PPCI were observed. STR was measured between 60-90 minutes after the procedure and determined as complete (higher than or equal to 70%), partial (30-69%), or absent (less than 30%). Chi-square tests and multivariate logistic regression were used in the statistical tests. Results: Complete STR was achieved in 56.7% of patients, partial STR in 30.0%, and absent STR in 13.3%. Patients with complete STR had significantly lower rates of heart failure (6.9% vs. 37.5%), arrhythmias (4.9% vs. 25.0%), recurrent ischemia (2.9% vs. 16.7%), and in-hospital mortality (2.0% vs. 20.8%) compared to those with absent STR (p<0.05). Independent predictors of incomplete STR included symptom-to-balloon time >180 minutes, anterior STEMI location, and baseline TIMI flow 0–1. Conclusion: STR is an easy, affordable, and potent prognostic indicator in STEMI patients after PPCI. Participation in the routine practice of STR assessment can improve the risk stratification and lead to managing patients more effectively.