Degree of ST-segment elevation in patients with STEMI reflects the acute ischemic burden and the salvage potential
Divan Gabriel Topal1, Thomas Engstrøm2, Lars Nepper-Christensen1
1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
Insights
The sum of ST-segment elevation (∑STE) on ECG before primary percutaneous coronary intervention (PPCI) correlates with myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients. This ECG marker helps predict infarct size and salvage, guiding treatment decisions.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Biomedical Engineering
Background:
- ST-segment elevation myocardial infarction (STEMI) diagnosis relies on electrocardiogram (ECG) ST-segment elevation (STE).
- The prognostic significance of the sum of STE (∑STE) before primary PCI (PPCI) is not fully understood.
- This study investigates the association between ∑STE and infarct characteristics.
Purpose of the Study:
- To evaluate the relationship between pre-PPCI ∑STE and the area at risk, infarct size, and myocardial salvage in STEMI patients.
- To determine if pre-PPCI ∑STE can predict myocardial damage extent.
- To explore the influence of coronary blood flow (TIMI flow) on this association.
Main Methods:
- Cardiac magnetic resonance (CMR) was used to assess infarct size and area at risk in 503 STEMI patients.
- CMR imaging was performed at day 1 and day 92 post-STEMI.
- The sum of ST-segment elevation (∑STE) from the ECG prior to PPCI was analyzed in relation to CMR findings and pre-PPCI TIMI flow.
Main Results:
- ∑STE demonstrated a linear association with increased area at risk, larger final infarct size, and greater microvascular obstruction.
- ∑STE was inversely associated with final myocardial salvage.
- This association between ∑STE and myocardial salvage was significant in patients with pre-PPCI TIMI flow 2/3, but not in those with TIMI flow 0/1.
Conclusions:
- Pre-PPCI ∑STE is a valuable ECG marker for assessing the extent of myocardium at risk in STEMI.
- In patients with TIMI flow 0/1, ∑STE reflects the area at risk influencing infarct size.
- In patients with TIMI flow 2/3, ∑STE indicates both the area at risk and myocardial salvage, impacting overall myocardial damage.
Background:
ST-segment elevation myocardial infarction (STEMI) is clinically diagnosed by significant ST-segment elevation (STE) in the electrocardiogram (ECG). The importance of the sum of significant ST-segment elevation (∑STE) before primary percutaneous coronary intervention (PPCI) - considered an indicator of the degree of ischemia - is sparse. We evaluated the association of ∑STE before PPCI with respect to area at risk, infarct size and myocardial salvage.
Methods:
A total of 503 patients with STEMI and available cardiac magnetic resonance (CMR) were included. CMR was performed at day 1 (interquartile range [IQR], 1-1) and at follow-up at day 92 (IQR, 88-96). The ECG before PPCI with the most prominent STE was used for analysis.
Results:
∑STE divided into quartiles were progressive linearly associated with area at risk (p < 0.001), final infarct size (p < 0.001) and extent of microvascular obstruction (p < 0.001) and inverse linearly associated with final myocardial salvage (p < 0.001). Similar results were found for linear regression analyses. However, ∑STE was not associated with final myocardial salvage in patients with pre-PCI TIMI (thrombolysis in myocardial infarction) flow 0/1 (p = 0.24) in contrast to patients with pre-PCI TIMI flow 2/3 (p ≤ 0.001).
Conclusion:
In patients with STEMI presenting within 12 h of symptom onset, the degree of STE in the ECG before PPCI is a marker of the extent of myocardium at risk that in turn affects the infarct size in patients with pre-PCI TIMI flow 0/1, whereas the degree of STE in patients with pre-PCI TIMI flow 2/3 is a marker of the extent of the myocardium at risk as well as myocardial salvage - both affecting the myocardial damage.
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