Clinical implications of serial changes in ST-segment elevation after reperfusion in patients with anterior acute
Jun Okuda1, Masami Kosuge, Toshiaki Ebina
1Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Insights
In patients with acute myocardial infarction (AMI), an increase in ST-segment elevation after reperfusion, even with initial resolution, indicates a larger infarction and worse left ventricular (LV) function. This finding impacts understanding of reperfusion injury and cardiac recovery.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Imaging
Background:
- The link between ST-segment changes post-reperfusion and left ventricular (LV) function in acute myocardial infarction (AMI) is not fully understood.
- Assessing ST-segment dynamics after reperfusion is crucial for predicting cardiac outcomes.
Purpose of the Study:
- To investigate the relationship between serial ST-segment elevation changes after reperfusion and LV function in patients with anterior AMI.
- To determine if ST-segment changes beyond initial resolution predict infarct size and LV function.
Main Methods:
- 164 patients with reperfused anterior AMI within 6 hours of symptom onset were studied.
- Sum of ST-segment deviation (SigmaST) was measured on admission, and at 1 and 24 hours post-reperfusion.
- Patients were grouped based on ST resolution and subsequent ST-segment changes.
Main Results:
- An increase in ST-segment elevation between 1 and 24 hours post-reperfusion, despite initial resolution, was associated with higher peak creatine kinase levels.
- Patients with increasing ST-segment elevation showed significantly lower LV ejection fraction at 6-month follow-up compared to those with stable or resolving ST-segments.
- These findings suggest a correlation between late ST-segment changes and adverse cardiac remodeling.
Conclusions:
- Late increases in ST-segment elevation after reperfusion in anterior AMI are linked to larger infarct size.
- Poorer LV function is observed in patients exhibiting ST-segment elevation increase between 1-24 hours post-reperfusion.
- Serial ST-segment monitoring provides valuable prognostic information regarding LV function after reperfusion therapy.
Background:
In patients with acute myocardial infarction (AMI), the relationship of serial changes in ST-segment elevation after reperfusion to left ventricular (LV) function remains unclear.
Methods And Results:
The study group comprised 164 patients with reperfused anterior AMI within 6 h of symptom onset. The sum of ST-segment deviation was calculated on admission (SigmaST-admission), and 1 h (SigmaST-1 h) and 24 h (SigmaST-24 h) after reperfusion. ST resolution was defined as a reduction in SigmaST-1 h of > or =50% as compared with SigmaST-admission. Patients were classified into 3 groups: group A, 82 patients with ST resolution in whom SigmaST-1 h > or = SigmaST-24 h; group B, 37 patients with ST resolution in whom SigmaST-1 h < SigmaST-24 h; group C, 45 patients without ST resolution. Peak creatine kinase were higher in groups B and C than in group A (4,578+/-2,176, 4,236+/-2,638, 2,222+/-1,926 mU/ml, p<0.01). At 6 months follow-up, the LV ejection fraction were lower in groups B and C than in group A (53+/-8, 54+/-12, 62+/-9%, p<0.01).
Conclusions:
An increase in ST-segment elevation 1-24 h after reperfusion, despite ST resolution, is associated with a larger infarction and poorer LV function in patients with reperfused anterior AMI.
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