Prognostic Value of Cumulative ST-Segment Elevation for In-Hospital Outcomes in Patients with Anterior ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

Objectives: To evaluate the association between the cumulative sum of ST-segment elevation (ΣSTE) measured on the admission ECG and in-hospital clinical outcomes in patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI). Methodology: This descriptive longitudinal study was conducted at the Department of Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi. Consecutive adult patients aged 18–75 years presenting with first-time anterior STEMI within 24 hours of symptom onset and undergoing primary PCI were enrolled. ΣSTE was measured on the initial ECG obtained at emergency department presentation. Patients were categorized into high-risk (ΣSTE ≥13 mm) and low-risk (ΣSTE <13 mm) groups based on the cohort-specific median value. The primary outcome was in-hospital mortality, while secondary outcomes included heart failure, cardiogenic shock, and arrhythmias. Multivariable logistic regression was performed to assess the independent association between ΣSTE and in-hospital mortality. Results: A total of 171 patients were included in the final analysis (mean age 55.3 ± 11.7 years; 85.4% male). Overall in-hospital mortality was 12.9%. Mortality was significantly higher in the high ΣSTE group compared with the low ΣSTE group (22.1% vs. 1.3%, p<0.001). Adverse cardiac outcomes including heart failure (50.5% vs. 19.7%, p<0.001), cardiogenic shock (33.7% vs. 10.5%, p<0.001), and arrhythmias (20.0% vs. 2.6%, p=0.001) were also more frequent in patients with higher ΣSTE values. After adjusting for age, diabetes mellitus, hypertension, smoking status, and door-to-balloon time, ΣSTE ≥13 mm remained independently associated with in-hospital mortality (adjusted OR=16.39; 95% CI: 1.89–142.1; p=0.011), although the wide confidence interval reflects limited event numbers. Conclusion: Admission ΣSTE ≥13 mm on the initial ECG is associated with increased in-hospital mortality and adverse cardiac outcomes in patients with anterior STEMI undergoing primary PCI. As an easily obtainable electrocardiographic parameter, ΣSTE may facilitate rapid early risk stratification in acute clinical settings. However, given the cohort-specific threshold and single-center design, further multicenter validation is warranted.