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Myocardial damage after successful thrombolysis is associated with the duration of ST re-elevation at reperfusion
M Ochiai1, T Isshiki, Y Hirose
1Second Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Insights
Sustained ST re-elevation after reperfusion therapy for myocardial infarction indicates significant left ventricular dysfunction and elevated creatine kinase levels. Transient ST re-elevation does not show the same adverse outcomes, suggesting less myocardial damage.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- ST-segment elevation during reperfusion after myocardial infarction is a complex phenomenon.
- Understanding its prognostic significance requires strict patient selection and clear definitions.
Purpose of the Study:
- To investigate the prognostic value of ST-segment re-elevation at reperfusion in patients with anterior myocardial infarction.
- To correlate ST-segment behavior with left ventricular function and myocardial damage markers.
Main Methods:
- Twenty-nine patients with first anterior myocardial infarction, single-vessel disease, and successful urokinase-induced recanalization were analyzed.
- Patients were grouped based on ST-segment deviation at reperfusion: sustained re-elevation, transient re-elevation, or ST reduction.
- Left ventricular function and regional wall motion were assessed via cineventriculography 4 weeks post-intervention.
- Peak creatine kinase (CK) activity was measured as a marker of myocardial injury.
Main Results:
- Patients with sustained ST re-elevation (Group A) exhibited significantly lower left ventricular ejection fraction (44%) and poorer regional wall motion compared to transient (Group B, 61%) and reduced (Group C, 60%) groups (p < 0.01).
- Peak CK activity was markedly higher in Group A (5848 IU) versus Groups B (2485 IU) and C (1889 IU) (p < 0.05).
- Sustained ST re-elevation correlated with extensive myocardial damage.
Conclusions:
- Sustained ST re-elevation following successful reperfusion in anterior myocardial infarction is a strong indicator of significant left ventricular dysfunction.
- Transient ST re-elevation is not associated with adverse left ventricular remodeling or increased myocardial injury.
- The pattern of ST-segment deviation at reperfusion provides crucial prognostic information regarding the extent of myocardial damage.
Abstract:
The purpose of this study was to investigate the significance of ST re-elevation at reperfusion using strict criteria for patient inclusion and exclusion. Twenty-nine patients who had a first anterior infarction with single-vessel disease, successful recanalization by intracoronary thrombolysis (ICT) with urokinase, and an angiographically confirmed patent infarct-related artery after 4 weeks, were divided into three groups according to the deviation of the ST segment at reperfusion: Group A, 10 patients with sustained ST re-elevation; Group B, 10 patients with transient ST re-elevation; and Group C, 9 patients with ST reduction. Left ventricular (LV) function was evaluated from cineventriculograms performed in the 30 degrees right anterior projection 4 weeks after ICT. LV ejection fraction and regional wall motion of the infarct area, evaluated by the centerline method (SD/chords), were significantly lower in Group A (44 +/- 10%, -3.2 +/- 0.4) than in Group B (61 +/- 9%, -1.9 +/- 0.7) and Group C (60 +/- 5%, -2.0 +/- 0.4) (p < 0.01). Peak creatine kinase (CK) activity was significantly higher in Group A (5848 +/- 2112 IU) than in Group B (2485 +/- 1254 IU) and Group C (1889 +/- 1525 IU) (p < 0.05). These data suggest that a sustained ST re-elevation at reperfusion was strongly associated with marked LV dysfunction and higher peak CK activity. It was concluded that sustained, not transient, ST re-elevation associated with successful reperfusion indicates extensive myocardial damage.