T-Wave Normalization during Follow-Up After Early and Late Mechanical Recanalization of Infarct-Related Artery With and Without Stent Implantation

Eglė Kalinauskienė,Albinas Naudžiūnas

doi:10.3390/medicina48090067

Eglė Kalinauskienė, Albinas Naudžiūnas

Open Access

https://doi.org/10.3390/medicina48090067

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Journal: Medicina	Publication Date: Aug 5, 2012
License type: CC BY 4.0

Affiliation: Lithuanian University of Health Sciences

Abstract

The aim of this study was to evaluate T-wave normalization during the 6-month follow-up in the patients who underwent early or late mechanical recanalization of the infarct-related artery with and without stent implantation. A total of 248 consecutive patients were divided into the following groups: early angioplasty (≤24 hours) without (n=114) or with stents (n=6) and late angioplasty (>24 hours) without (n=114) or with stents (n=14). The changes in T-wave recovery, QRS score, and echocardiographic left ventricular ejection fraction were compared between the groups. At 3 months, a greater percentage of patients in the group of early angioplasty with stents had again positive T wave than in the group of early angioplasty without stents (75% vs. 35%, P=0.05). After 6 months, all patients in the group of early angioplasty with stents had again positive T wave. A significant increase in left ventricular ejection fraction after 3 months was also observed only in the groups of early angioplasty, especially that with stents (30.0% [SD, 3.5%] vs. 38.4% [SD, 5.2%], P=0.008). However, there was no significant difference in the QRS score in this group comparing the data at discharge and after 3 months (5.4 [SD, 4.3] vs. 5.0 [SD, 1.9], P>0.05). The group of early angioplasty with stents showed the best recovery of T wave and left ventricular ejection fraction, but the QRS score did not change significantly from discharge to the 3-month follow-up, so the evolution of T wave corresponded to an improvement in ejection fraction at follow-up better than the evolution of QRS score.

Highlights

Primary percutaneous coronary intervention (PCI) with stent implantation has become accepted as the preferred interventional strategy in STsegment elevation myocardial infarction (STEMI) [1, 2]
The group of early angioplasty with stents showed the best recovery of T wave and left ventricular ejection fraction, but the QRS score did not change significantly from discharge to the 3-month follow-up, so the evolution of T wave corresponded to an improvement in ejection fraction at follow-up better than the evolution of QRS score
left ventricle (LV) ejection fraction at admission was lower in the groups of early PCI than in the corresponding groups of late PCI

Summary

Introduction

Primary percutaneous coronary intervention (PCI) with stent implantation has become accepted as the preferred interventional strategy in STsegment elevation myocardial infarction (STEMI) [1, 2]. Recently Sone et al have reported a remarkable recovery of a 65-yearold man with marked ST-elevation myocardial infarction, who was treated with PCI more than 2 days after onset [5]. Whilst an improvement in perfusion is the usual finding after successful angioplasty, there is considerable disparity between the angiographic appearance of restored TIMI flow in IRA and the electrocardiographic (ECG) signs of myocardial tissue reperfusion insufficiency manifested by persistent ST-segment elevation after recanalization [6]. Ito et al [7] demonstrated that the restoration of normal epicardial blood flow was not sufficient to ensure adequate myocardial reperfusion; the latter required perfusion at the level of the coronary microcirculation and myocytes. Myocardial perfusion in the distribution of the dilated artery was shown to improve progressively up to 3 months, but thereafter, no improvement was seen [8, 9]

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