Relation of ST-segment elevation before and after percutaneous transluminal coronary angioplasty to left ventricular area at risk, myocardial infarct size, and systolic function
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José F Rodríguez-Palomares1, Jaume Figueras-Bellot1, Martin Descalzo1
1Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall Hebrón Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Dynamic electrocardiography changes during ST-elevation myocardial infarction (STEMI) treatment predict outcomes. Early ST elevation sum predicts area at risk, while later changes correlate with infarct size and left ventricular function post-primary percutaneous coronary intervention.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Electrocardiography (ECG) is crucial for managing ST-elevation myocardial infarction (STEMI).
- The correlation between dynamic ECG changes during primary percutaneous coronary intervention (PCI) and cardiovascular magnetic resonance (CMR) findings is not well understood.
- Assessing ECG's predictive value for myocardial damage and function post-PCI is important.
Purpose of the Study:
- To evaluate the predictive capability of dynamic ST-segment changes before and after PCI.
- To correlate these ECG changes with myocardial area at risk (AAR), infarct size, and left ventricular function assessed by CMR.
- To determine the prognostic value of ST-segment resolution (resSTE) and sum of ST elevation (sumSTE) in STEMI patients undergoing PCI.
Main Methods:
- Eighty-five STEMI patients undergoing primary PCI were enrolled.
- ECG was recorded before and at multiple time points (1-120 hours) after PCI.
- CMR was performed during hospitalization and at 6-month follow-up to assess AAR, infarct size, ejection fraction, and microvascular obstruction.
Main Results:
- Pre-PCI sumSTE and number of ST elevation (STE) were strongly associated with AAR.
- Lack of complete ST-segment resolution (resSTE ≥70%) post-PCI correlated with larger infarct size, microvascular obstruction, and reduced myocardial salvage.
- Post-PCI sumSTE at 120 hours was the strongest predictor of infarct size, left ventricular volumes, and ejection fraction at both hospitalization and 6-month follow-up.
Conclusions:
- Admission sumSTE effectively correlates with the myocardial area at risk in STEMI patients.
- SumSTE measured 120 hours after PCI, rather than early ST-segment resolution, provides a better correlation with infarct size and left ventricular function.
- Dynamic ECG monitoring during and after PCI offers valuable prognostic information in STEMI management.
Abstract:
Electrocardiography is an excellent tool for decision making in patients with ST elevation myocardial infarction (STEMI). However, little is known on the correlation between its dynamic changes during primary percutaneous coronary intervention (PCI) and the anatomic information provided by cardiovascular magnetic resonance. The study aimed to assess the predictive value of dynamic ST-segment changes before and after PCI on myocardial area at risk (AAR), infarct size, and left ventricular function in patients with STEMI. Eighty-five consecutive patients with a first STEMI were included. An electrocardiogram was recorded before and after PCI at 1, 24, 48, 72, and 120 hours. Sum of ST elevation (sumSTE), the number of STE, and STE resolution (resSTE) were determined. Complete resSTE was defined as ≥70% resolution, and patients were classified into 3 groups: group 1 (resSTE 1 hour after PCI) n = 39; group 2 (resSTE 120 hour after PCI) n = 27; and group 3, without resSTE (n = 19). Cardiovascular magnetic resonance was performed during hospitalization and at 6 months. Left ventricular volumes, ejection fraction, AAR, infarct size, myocardial salvage index, and microvascular obstruction were determined. Before PCI, the number of STE and sumSTE were best associated with AAR (p <0.001). After PCI, lack of resSTE (group 3) was associated with larger infarct size, MVO, and lower myocardial salvage index. However, sumSTE at 120 hours after PCI best discriminated patients with larger infarct size, ventricular volumes, and lower ejection fraction during hospitalization and at follow-up. In conclusion, admission sumSTE best correlates with AAR, whereas sumSTE at 120 hours rather than early resSTE best correlates with infarct size and left ventricular volumes during hospitalization and at 6 months.
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