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Persistent ST-segment elevation after primary stenting for acute myocardial infarction: its relation to left
San-Gon Lee1, Jong-Pil Cheong, Je-Kyoun Shin
1Department of Medicine, Ulsan University Hospital, Dong-go, Korea. sglee@uuh.ulsan.kr
Insights
Persistent ST elevation after primary stenting for acute myocardial infarction (AMI) indicates poor left ventricular (LV) recovery. This finding highlights ST elevation as a predictor of impaired microvascular reperfusion and reduced LV function post-intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Early restoration of coronary artery patency in acute myocardial infarction (AMI) improves survival.
- However, early recanalization does not guarantee left ventricular (LV) function recovery.
Purpose of the Study:
- To evaluate the relationship between persistent ST-segment elevation after primary stenting in AMI and subsequent LV recovery.
- To determine if ST-segment elevation predicts microvascular injury and impacts LV function.
Main Methods:
- Prospective enrollment of 31 patients undergoing primary stenting for AMI.
- Serial ST-segment analysis via 12-lead ECG before and after intervention to assess microvascular injury.
- Echocardiography performed on Day 1 and 3 months post-stenting to evaluate LV function.
Main Results:
- Patients with persistent ST elevation (> or = 50% of peak) showed smaller infarct zone wall-motion score index and reduced ejection fraction at 3 months compared to those with ST resolution.
- Persistent ST elevation correlated with poorer wall motion recovery and impaired microvascular reperfusion (corrected TIMI frame count).
- Time to reperfusion was not significantly related to wall motion recovery.
Conclusions:
- Persistent ST-segment elevation post-primary stenting is a marker of impaired microvascular reperfusion.
- This persistent elevation predicts poor left ventricular recovery 3 months after primary stenting for AMI.
- ST-segment analysis is a valuable tool for assessing microvascular status and predicting outcomes in AMI patients.
Background:
Early restoration of coronary artery patency in acute myocardial infarction (AMI) has been linked to improvement in survival. However, early recanalization of an occluded epicardial coronary artery by either thrombolytic agents or percutaneous transluminal coronary angioplasty (PTCA) does not necessarily lead to left ventricular (LV) function recovery.
Hypothesis:
The aim of this study was to evaluate the relation between persistent ST elevation shortly after primary stenting for acute myocardial infarction (AMI) and LV recovery.
Methods:
Thirty-one patients with primary stenting for AMI were prospectively enrolled. To evaluate the extent of microvascular injury, serial ST-segment analysis on a 12-lead electrocardiogram recording just before and at the end of the coronary intervention was performed. Persistent ST-segment elevation (Persistent Group, n = 11) was defined as > or = 50% of peak ST elevation and resolution (Resolution Group, n = 20) was defined as < 50% of peak ST elevation. Echocardiography was performed on Day 1 and 3 months after primary stenting.
Results:
At 3 months, infarct zone wall-motion score index (WMSI, 2.1 +/- 0.6 vs. 2.7 +/- 0.3, p < 0.05) was smaller in the Resolution Group than in the Persistent Group, whereas wall motion recovery index (RI, 0.4 +/- 0.3 vs. 0.1 +/- 0.2, p < 0.05) and ejection fraction (58 +/- 5 vs. 43 +/- 10%, p < 0.05) were larger in the Resolution Group than in the Persistent Group. The extent of persistent ST elevation (% ST) shortly after successful recanalization of the infarct-related artery was significantly related to RI at 3 months (r = -0.4, p < 0.05). However, time to reperfusion was not related to RI at 3 months. There was also significant correlation between corrected TIMI frame count and %ST (r = 0.4, p < 0.05).
Conclusions:
Persistent ST-segment elevation shortly after successful recanalization (> or = 50% of the peak value), as a marker of impaired microvascular reperfusion, predicts poor LV recovery 3 months after primary stenting for AMI.