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Published on: May 28, 2019
Relation of lateral ST-segment elevation pattern to myocardial salvage in patients with recanalized anterolateral
Masami Kosuge1, Kazuo Kimura, Toshiyuki Ishikawa
1Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Insights
In anterior acute myocardial infarction (AMI), a specific ST-segment elevation pattern in lateral leads indicates poorer outcomes. Greater ST elevation in lead I versus lead aVL correlates with worse reperfusion and larger infarct size.
Area of Science:
- Cardiology
- Electrocardiography
- Myocardial Infarction
Background:
- Anterior acute myocardial infarction (AMI) with lateral ST-segment elevation is linked to poor prognosis.
- The prognostic significance of specific lateral ST-segment elevation patterns remains underexplored.
Purpose of the Study:
- To investigate the relationship between lateral ST-segment elevation patterns and myocardial reperfusion.
- To assess the correlation between these electrocardiographic patterns and infarct size in AMI patients.
Main Methods:
- 111 patients with first AMI and anterolateral ST-segment elevation were analyzed.
- Patients were grouped based on lead I vs. lead aVL ST-segment elevation.
- Left ventricular ejection fraction (LVEF) was assessed via ventriculography.
Main Results:
- No significant differences in demographics or reperfusion times were observed between groups.
- Patients with greater ST elevation in lead I vs. aVL showed impaired myocardial reperfusion (blush grade 0-1).
- This group also exhibited higher peak creatine kinase levels and lower LVEF.
Conclusions:
- Equivalent or greater ST-segment elevation in lead I compared to lead aVL is associated with impaired reperfusion.
- This pattern predicts less myocardial salvage in recanalized AMI patients.
- The findings highlight the prognostic value of specific lateral lead ST-segment elevation patterns in AMI.
Background:
Although anterior acute myocardial infarction (AMI) with ST-segment elevation in lateral leads is associated with a poor prognosis, the significance of the pattern of lateral ST-segment elevation has not been examined.
Hypothesis:
The aim of the study was to examine the relation of the pattern of lateral ST-segment elevation to myocardial reperfusion and infarct size in patients with AMI.
Methods:
We studied 111 patients who had a first AMI presenting with anterolateral ST-segment elevation and Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow of the left anterior descending coronary artery within 6 h from symptom onset. Patients were classified into two groups according to the pattern of lateral ST-segment elevation on the admission electrocardiogram: Group 1, 42 patients with equivalent or greater ST-segment elevation in lead I than in lead aVL, and Group 2, 69 patients with lesser ST-segment elevation in lead I in than in lead aVL. Left ventricular ejection fraction (LVEF) was measured by predischarge left ventriculography.
Results:
There were no differences between the two groups in age, gender, time from onset to recanalization, culprit lesion, or collateral development. Group 1 patients had a higher probability of impaired myocardial reperfusion as indicated by a myocardial blush grade of 0 or 1 after recanalization, a higher peak creatine kinase level, and a lower LVEF than Group 2 patients (p = 0.0001, respectively).
Conclusions:
We conclude that equivalent or greater ST-segment elevation in lead I than in lead aVL is associated with impaired myocardial reperfusion and less myocardial salvage in patients with recanalized AMI who present with anterolateral ST-segment elevation on the admission electrocardiogram.
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