The significance of persistent ST elevation versus early resolution of ST segment elevation after primary PTCA
S Matetzky1, M Novikov, L Gruberg
1Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Insights
Early ST segment elevation resolution after primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) indicates better outcomes. Lack of resolution suggests microvascular damage and poorer myocardial salvage, impacting patient prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Microvascular damage can impede myocardial reperfusion despite successful coronary artery recanalization in acute myocardial infarction (AMI).
- This microvascular dysfunction may limit the benefits of early reperfusion therapies like primary percutaneous transluminal coronary angioplasty (PTCA).
Purpose of the Study:
- To investigate the prevalence of early ST segment elevation resolution following primary PTCA in AMI patients.
- To assess the clinical significance and prognostic implications of early ST segment elevation resolution.
Main Methods:
- A study of 117 patients undergoing primary PTCA for AMI with angiographically confirmed TIMI III flow.
- Patients were categorized based on > or =50% ST segment elevation reduction on post-procedure ECG compared to pre-procedure ECG.
Main Results:
- 76% of patients showed early ST segment elevation resolution (Group A), while 24% did not (Group B).
- Group A demonstrated significantly better predischarge left ventricular ejection fraction (LVEF).
- Group B experienced higher in-hospital and long-term mortality, and increased rates of congestive heart failure (CHF).
Conclusions:
- Absence of early ST segment elevation resolution after primary PTCA identifies patients with poorer outcomes.
- This lack of resolution likely signifies microvascular damage and reduced myocardial salvage, diminishing the benefits of reperfusion therapy.
Objectives:
To determine the prevalence and clinical significance of early ST segment elevation resolution after primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI).
Background:
Despite angiographically successful restoration of coronary flow early during AMI, adequate myocardial reperfusion might not occur in a substantial portion of the jeopardized myocardium due to microvascular damage. This phenomenon comprises the potentially beneficial effect of early recanalization of the infarct related artery (IRA).
Methods:
Included in the study were 117 consecutive patients who underwent angiographically successful [Thrombolysis in Myocardial Infarction (TIMI III)] primary PTCA. The patients were classified based on the presence or absence of reduction > or =50% in ST segment elevation in an ECG performed immediately upon return to the intensive cardiac care unit after the PTCA in comparison with ECG before the intervention.
Results:
Eighty-nine patients (76%) had early ST segment elevation resolution (Group A) and 28 patients (24%) did not (Group B). Group A and B had similar clinical and hemodynamic features before referring to primary PTCA, as well as similar angiographic results. Despite this, ST segment elevation resolution was associated with better predischarge left ventricular ejection fraction (LVEF) (44.7 +/- 8.0 vs. 38.2 +/- 8.5, p < 0.01). Group B patients, as compared with those of Group A, had a higher incidence of in-hospital mortality (11% vs. 2%, p = 0.088), congestive heart failure (CHF) [28% vs. 19%, odds ratio (OR) = 4, 95% confidence interval (CI) 1 to 15, p = 0.04], higher long-term mortality (OR = 7.3, 95% CI 1.9 to 28, p = 0.004 with Cox proportional hazard regression analysis) and long-term CHF rate (OR = 6.5, 95% CI 1.3 to 33, p = 0.016 with logistic regression).
Conclusions:
Absence of early ST segment elevation resolution after angiographically successful primary PTCA identifies patients who are less likely to benefit from the early restoration of flow in the IRA, probably because of microvascular damage and subsequently less myocardial salvage.
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