ST-segment resolution as a marker for severe myocardial fibrosis in ST-segment elevation myocardial infarction
Qian Dong1, Xuesong Wen2, Guanglei Chang1
1Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, China.
Insights
ST-segment resolution (STR) below 40.15% after percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients predicts thicker myocardial scars. This finding aids in assessing scar extent post-PCI.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely intervention to limit myocardial damage.
- Assessing myocardial scar extent after percutaneous coronary intervention (PCI) is crucial for patient prognosis.
- ST-segment resolution (STR) is an early indicator of reperfusion success but its correlation with scar thickness needs further investigation.
Purpose of the Study:
- To determine the relationship between ST-segment resolution (STR) and myocardial scar thickness following PCI in STEMI patients.
- To evaluate the predictive value of STR for the development of transmural versus non-transmural myocardial scars.
- To assess the association between STR and myocardial scar size.
Main Methods:
- Forty-two STEMI patients undergoing PCI were studied.
- ST-segment elevations were measured at admission and 24 hours post-PCI.
- Late gadolinium-enhanced cardiac magnetic resonance imaging (CMR-LGE) assessed myocardial scar thickness and size 7 days post-PCI.
Main Results:
- STR demonstrated high sensitivity (96%) and specificity (88%) in predicting transmural scars at a cutoff of 40.15%.
- Patients with STR < 40.15% had a 170.90-fold increased likelihood of developing transmural scars.
- STR percentage significantly correlated with myocardial scar thickness and size.
Conclusions:
- An STR value below 40.15% at 24 hours post-PCI is a significant predictor of myocardial scar thickness in STEMI patients.
- STR provides valuable diagnostic information for assessing the extent of myocardial scarification.
- These findings can help refine risk stratification and management strategies for STEMI patients.
Objective:
To investigate the relationship between ST-segment resolution (STR) and myocardial scar thickness after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Methods:
Forty-two STEMI patients with single-branch coronary artery stenosis or occlusion were enrolled. ST-segment elevations were measured at emergency admission and at 24 h after PCI. Late gadolinium-enhanced cardiac magnetic resonance imaging (CMR-LGE) was performed 7 days after PCI to evaluate myocardial scars. Statistical analyses were performed to assess the utility of STR to predict the development of transmural (> 75%) or non-transmural (< 75%) myocardial scars, according to previous study.
Results:
The sensitivity and specificity of STR for predicting transmural scars were 96% and 88%, respectively, at an STR cut-off value of 40.15%. The area under the curve was 0.925. Multivariate logistic proportional hazards regression analysis disclosed that patients with STR < 40.15% had a 170.90-fold higher probability of developing transmural scars compared with patients with STR ≥ 40.15%. Pearson correlation and linear regression analyses showed STR percentage was significantly associated with myocardial scar thickness and size.
Conclusion:
STR < 40.15% at 24 h after PCI may provide meaningful diagnostic information regarding the extent of myocardial scarification in STEMI patients.
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