Coronary Artery Disease
Rapid Reduction of ST-Segment Elevation After Successful Direct Angioplasty in Acute Myocardial Infarction

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Abstract

The aim of this study was to evaluate whether assessment of ST-segment changes in the 12-lead electrocardiogram from admission to 30 minutes after successful direct coronary angioplasty can predict myocardial damage and functional outcome in patients with acute myocardial infarction (AMI). Of 158 consecutive patients, 117 (92 men, aged 61 ± 11 years) were prospectively classified into 2 groups: group 1, <50% reduction in ST-segment elevation in a single selected lead (42 patients); group 2, ≥50% reduction in ST-segment elevation (75 patients). Baseline characteristics were similar except for anterior wall AMI and Killip class >2, which were more prevalent in group 1. Peak creatine kinase was significantly higher in group 1 (3,690 ± 2,809 vs 2,592 ± 1,960 U/L; p = 0.018). One-month echocardiograms were obtained in 102 patients (87%). Infarct zone wall motion score index decreased in both groups, but this reduction was higher in group 2 (p <0.001). Functional recovery (>0.22 decrease in infarct zone wall motion score index) was observed in 34% of group 1 and in 78% of group 2 patients (p <0.001). One-month left ventricular ejection fraction was higher in group 2 (p <0.001). At multivariate analysis, reduction of ST-segment elevation was the only independent predictor of functional recovery (p <0.001). In conclusion, ST-segment analysis provides rapid and inexpensive information allowing identification of patients who are likely to benefit the most from myocardial reperfusion as early as 30 minutes after the last balloon inflation.

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)

  • HD White et al.

    Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction

    N Engl J Med

    (1987)
  • 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

    (1993)
  • AM Lincoff et al.

    Illusion of reperfusion. Does anyone achieve optimal reperfusion during acute myocardial infarction?

    Circulation

    (1993)
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