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Utility of ST score on admission as a marker for outcome in acute myocardial infarction in a resource constrained setting

Introduction: An early and specific indicator is needed to prognosticate acute myocardial infarction (MI). This indicator should be simple, quick, reliable, non-invasive, inexpensive, and easily applicable to all the patients especially in a resource-constrained setting. The present study tried to evaluated efficacy of ST score on electrocardiography as a prognostic indicator in acute ST-elevated MI (STEMI). Materials and Methods: A prospective study was conducted on consecutive thrombolysed patients of STEMI admitted in teaching hospital. ST score defined as sum of ST-segment elevation in all leads related to infarct location was calculated in standard 12-lead electrocardiographic tracings immediately on admission and then serially postthrombolysis at 90 min, 6 h, 24 h, and day 3 and 5 of admission. Primary end-point was all-cause mortality at 30 days. Results: The mean ST score between survivor and nonsurvivor was 19.27 mm and 16.16 mm, respectively. The score on admission in patients who had poor outcome was significantly higher than those who had good outcome (poor = 20.27 mm vs. good outcome = 12.47 mm; P = 0.002). This difference persisted throughout but was maximum at 90-min postthrombolysis (13.82 mm vs. 7.39 mm; P = 0.0001). The optimal cutoff point maximizing sensitivity and specificity was found at 11 mm for both anterior- and inferior wall MI (IWMI) with a sensitivity of 73% and specificity of 58%. Conclusion: This study concludes that an increase of 1 mm in ST score increased the odds of complications by 1.06 (95% confidence interval [CI], 1.01–1.2) for anterior-wall MI and by 1.09 (95% CI, 0.96–1.2) for IWMI. In a resource-constrained health facility where electrocardiography may be the only available equipment, ST score can easily and effectively be used to stratify patients into high-risk and low-risk categories.