Coronary Artery DiseaseRapid Reduction of ST-Segment Elevation After Successful Direct Angioplasty in Acute Myocardial Infarction
Section snippets
Patient Population
Between January 1995 and March 1996, 158 consecutive patients with AMI were referred to our catheterization laboratory for direct angioplasty within 6 hours of symptom onset. Of these patients, 117 (92 men, mean age 61 ± 11 years, range 36 to 84) were prospectively selected for the present study. Inclusion criteria were: (1) no history of myocardial infarction or of other heart disease except for coronary artery disease; (2) absence of conditions precluding the evaluation of ST-segment changes
Results
According to changes in ST-segment elevation, patients were divided into 2 groups: group 1 (no or <50% reduction in ST-segment elevation; n = 42); and group 2 (≥50% reduction in ST-segment elevation; n = 75).
Baseline demographic, clinical, and electrocardiographic characteristics were similar between the 2 groups except for a higher prevalence of anterior infarction and Killip class >2 in group 1 patients (Table 1). Angiographic data are summarized in Table 2. No difference between the 2 groups
Discussion
In our study, only patients with successful direct angioplasty were included. Successful angioplasty was defined as the restoration of an anterograde TIMI flow grade 3 and a <30% residual stenosis. In this setting, rapid reduction in ST-segment elevation may be the marker of a myocardial reperfusion effective in reducing ischemic injury and in salvaging myocardium. In contrast, persistence of ST-segment elevation may be an indicator of irreversible myocardial damage, which occurred despite the
References (26)
- et al.
Preservation of cardiac function by coronary thrombolysis during acute myocardial infarction: fact or myth?
J Am Coll Cardiol
(1987) - et al.
Noninvasive detection of coronary artery patency using continuous ST-segment monitoring
Am J Cardiol
(1986) - et al.
Continuously updated 12-lead ST-segment recovery analysis for myocardial infarct artery patency assessment and its correlation with multiple simultaneous early angiographic observations
Am J Cardiol
(1993) - et al.
ST segment tracking for rapid determination of patency of the infarct-related artery in acute myocardial infarction
J Am Coll Cardiol
(1995) Determinants of improved left ventricular function after thrombolytic therapy in acute myocardial infarction
J Am Coll Cardiol
(1987)- et al.
Ability of the no-reflow phenomenon during an acute myocardial infarction to predict left ventricular dysfunction at one-month follow-up
Am J Cardiol
(1995) - et al.
Myocardial contrast echocardiography versus dobutamine echocardiography for predicting functional recovery after acute myocardial infarction treated with primary coronary angioplasty
J Am Coll Cardiol
(1996) - et al.
Early assessment of outcome by ST-segment analysis after thrombolytic therapy in acute myocardial infarction
Am Heart J
(1994) - et al.
Is ST segment re-elevation associated with reperfusion an indicator of marked myocardial damage after thrombolysis?
J Am Coll Cardiol
(1993) - et al.
Abrupt augmentation of ST segment elevation associated with successful reperfusion: a sign of diminished myocardial salvage
Am Heart J
(1995)
Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction
N Engl J Med
The effect of tissue plasminogen activator, streptokinase, or both on coronary artery patency, ventricular function, and survival after acute myocardial infarction
N Engl J Med
Illusion of reperfusion. Does anyone achieve optimal reperfusion during acute myocardial infarction?
Circulation
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