{"id":"fdbc251a16ae","type":"article","url":"https://hartvaat.nl/2016/04/01/ischemisch-risicogebied-en-reperfusiemethode-bij-stemi-klinische-implicaties/","title":"Ischemisch risicogebied en reperfusiemethode bij STEMI: klinische implicaties","title_en":"Implications of ischaemic area at risk and mode of reperfusion in ST-elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2015-308075","source_url":"https://doi.org/10.1136/heartjnl-2015-308075","authors":["Kevin R Bainey","Claudio Fresco","Yinggan Zheng","Sigrun Halvorsen","Antonio Carvalho","Miodrag Ostojic","Patrick Goldstein","Anthony H Gershlick","Cynthia M Westerhout","Frans Van de Werf","Paul W Armstrong"],"significance":5,"published":"2016-04-01","source_date":"2016-04-01","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/klepprothese-mechanisch-biologisch/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study examined the implications of ischemic area at risk and reperfusion mode in STEMI, comparing pharmacological and mechanical reperfusion strategies for patients presenting early after symptom onset.","created":"2026-07-03T10:26:01Z","updated":"2026-07-03T13:25:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de relatieve verdiensten van farmacologische versus mechanische reperfusie bij STEMI-patiënten die zich vroeg presenteren met een groot ischemisch risicogebied. Draagt bij aan de discussie over optimale reperfusiestrategie.","abstract_original":"OBJECTIVE: Uncertainty exists concerning the relative merits of pharmacological versus mechanical coronary reperfusion in patients presenting early with ST-elevation myocardial infarction (STEMI) with extensive myocardium at risk. Accordingly, we investigated whether the extent of baseline ST-segment shift was related to the response of either reperfusion modality in patients with STEMI presenting within 3 h of symptoms. METHODS: We analysed baseline ECGs from 1859 patients enrolled in the STrategic Reperfusion Early After Myocardial Infarction (STREAM) trial. The sum of ST-segment elevation (∑STE) and ST-segment deviation (∑STD) was categorised into quartiles and associations with the primary endpoint (30-day death/shock/congestive heart failure/re-myocardial infarction) for each reperfusion strategy (early fibrinolysis vs primary percutaneous coronary intervention) were explored. RESULTS: Overall, there was a progressive rise in the 30-day primary endpoint according to quartiles of baseline ∑STE (10.3% (0-5 mm), 12.4% (5.5-8.5 mm), 12.1% (9-13.5 mm), 17.6% (> 14.0 mm), p = 0.008) and ∑STD (9.0% (0-9 mm), 13.5% (9.5-14 mm), 14.7% (14.5-20 mm), 15.3% (> 20 mm), p = 0.019). Both ∑STE and ∑STD were associated with the primary endpoint (∑STE: p = 0.071; ∑STD: p = 0.024). However, there was no interaction between quartiles of baseline ∑STE or ∑STD and efficacy of either reperfusion strategy on the 30-day clinical outcomes (∑STE: p (interaction) = 0.696; ∑STD: p (interaction) = 0.542). CONCLUSIONS: These data demonstrate an association between ∑STE or ∑STD on the baseline ECG and clinical events at 30 days following reperfusion therapy in STEMI. More importantly, the response to different reperfusion strategies was not influenced by the extent of jeopardised myocardium. TRIAL REGISTRATION NUMBER: NCT00623623; Post-results."}