Myocardial Salvage In Patients Research Articles

Magnetic Resonance Imaging Delineates the Ischemic Area at Risk and Myocardial Salvage in Patients With Acute Myocardial Infarction

The area at risk (AAR) is a key determinant of myocardial infarction (MI) size. We investigated whether magnetic resonance imaging (MRI) measurement of AAR would be correlated with an angiographic AAR risk score in patients with acute MI. Bright-blood, T2-prepared, steady-state, free-precession MRI was used to depict the AAR in 50 consecutive acute MI patients, whereas infarct size was measured on gadolinium late-contrast-enhancement images. AAR was also estimated by the APPROACH and DUKE angiographic jeopardy scores and ST-segment elevation score. Myocardial salvage was calculated as AAR minus infarct size. Results are mean ± SD unless specified otherwise. Patients were 61 ± 12 years of age, 76% had an ST-segment elevation MI, and 20% had a prior MI. All underwent MRI 4 ± 2 days after initial presentation. The relation between MRI and the APPROACH angiographic estimates of AAR was similar (overall size relative to left ventricular mass was 32 ± 12% vs 30 ± 12%, respectively, P=0.33), correlated well (r = 0.78, P < 0.0001), and had a 2.5% bias on Bland-Altman analysis. The DUKE jeopardy score underestimated AAR relative to infarct size and was correlated less well with MRI (r = 0.39, P = 0.0055). ST-segment elevation score underestimated infarct size in 19 subjects (50%) and was not correlated with MRI (r = 0.27, P = 0.06). Myocardial salvage varied according to Thrombolysis in Myocardial Infarction flow grade at the end of angiography/percutaneous coronary intervention (P = 0.04), and Thrombolysis in Myocardial Infarction flow grade was a univariable predictor of myocardial salvage (P = 0.011). In multivariable analyses, infarct size was predicted by T2-prepared, steady-state, free-precession MRI (P < 0.0001). T2-prepared, steady-state, free-precession MRI delineates the AAR and enables estimation of myocardial salvage when coupled with a measurement of infarct size.

Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial

Remote ischaemic preconditioning attenuates cardiac injury at elective surgery and angioplasty. We tested the hypothesis that remote ischaemic conditioning during evolving ST-elevation myocardial infarction, and done before primary percutaneous coronary intervention, increases myocardial salvage. 333 consecutive adult patients with a suspected first acute myocardial infarction were randomly assigned in a 1:1 ratio by computerised block randomisation to receive primary percutaneous coronary intervention with (n=166 patients) versus without (n=167) remote conditioning (intermittent arm ischaemia through four cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff). Allocation was concealed with opaque sealed envelopes. Patients received remote conditioning during transport to hospital, and primary percutaneous coronary intervention in hospital. The primary endpoint was myocardial salvage index at 30 days after primary percutaneous coronary intervention, measured by myocardial perfusion imaging as the proportion of the area at risk salvaged by treatment; analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00435266. 82 patients were excluded on arrival at hospital because they did not meet inclusion criteria, 32 were lost to follow-up, and 77 did not complete the follow-up with data for salvage index. Median salvage index was 0.75 (IQR 0.50-0.93, n=73) in the remote conditioning group versus 0.55 (0.35-0.88, n=69) in the control group, with median difference of 0.10 (95% CI 0.01-0.22; p=0.0333); mean salvage index was 0.69 (SD 0.27) versus 0.57 (0.26), with mean difference of 0.12 (95% CI 0.01-0.21; p=0.0333). Major adverse coronary events were death (n=3 per group), reinfarction (n=1 per group), and heart failure (n=3 per group). Remote ischaemic conditioning before hospital admission increases myocardial salvage, and has a favourable safety profile. Our findings merit a larger trial to establish the effect of remote conditioning on clinical outcomes. Fondation Leducq.

Impact of Primary Coronary Angioplasty Delay on Myocardial Salvage, Infarct Size, and Microvascular Damage in Patients With ST-Segment Elevation Myocardial Infarction: Insight From Cardiovascular Magnetic Resonance

We investigated the extent and nature of myocardial damage by using cardiovascular magnetic resonance (CMR) in relation to different time-to-reperfusion intervals. Previous studies evaluating the influence of time to reperfusion on infarct size (IS) and myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) have yielded conflicting results. Seventy patients with STEMI successfully treated with primary percutaneous coronary intervention within 12 h from symptom onset underwent CMR 3 +/- 2 days after hospital admission. Patients were subcategorized into 4 time-to-reperfusion (symptom onset to balloon) quartiles: < or =90 min (group I, n = 19), >90 to 150 min (group II, n = 17), >150 to 360 min (group III, n = 17), and >360 min (group IV, n = 17). T2-weighted short tau inversion recovery and late gadolinium enhancement CMR were used to characterize reversible and irreversible myocardial injury (area at risk and IS, respectively); salvaged myocardium was defined as the normalized difference between extent of T2-weighted short tau inversion recovery and late gadolinium enhancement. Shorter time-to-reperfusion (group I) was associated with smaller IS and microvascular obstruction and larger salvaged myocardium. Mean IS progressively increased overtime: 8% (group I), 11.7% (group II), 12.7% (group III), and 17.9% (group IV), p = 0.017; similarly, MVO was larger in patients reperfused later (0.5%, 1.5%, 3.7%, and 6.6%, respectively, p = 0.047). Accordingly, salvaged myocardium markedly decreased when reperfusion occurred >90 min of coronary occlusion (8.5%, 3.2%, 2.4%, and 2.1%, respectively, p = 0.004). In patients with STEMI treated with primary percutaneous coronary intervention, time to reperfusion determines the extent of reversible and irreversible myocardial injury assessed by CMR. In particular, salvaged myocardium is markedly reduced when reperfusion occurs >90 min of coronary occlusion.

Impact of Heterogeneity of Human Peripheral Blood Monocyte Subsets on Myocardial Salvage in Patients With Primary Acute Myocardial Infarction

We examined whether distinct monocyte subsets contribute in specific ways to myocardial salvage in patients with acute myocardial infarction (AMI). Recent studies have shown that monocytes in human peripheral blood are heterogeneous. We studied 36 patients with primary AMI. Peripheral blood sampling was performed 1, 2, 3, 4, 5, 8, and 12 days after AMI onset. Two monocyte subsets (CD14(+)CD16(-) and CD14(+)CD16(+)) were measured by flow cytometry. The extent of myocardial salvage 7 days after AMI was evaluated by cardiovascular magnetic resonance imaging as the difference between myocardium at risk (T2-weighted hyperintense lesion) and myocardial necrosis (delayed gadolinium enhancement). Cardiovascular magnetic resonance imaging was also performed 6 months after AMI. Circulating CD14(+)CD16(-) and CD14(+)CD16(+) monocytes increased in AMI patients, peaking on days 3 and 5 after onset, respectively. Importantly, the peak levels of CD14(+)CD16(-) monocytes, but not those of CD14(+)CD16(+) monocytes, were significantly negatively associated with the extent of myocardial salvage. We also found that the peak levels of CD14(+)CD16(-) monocytes, but not those of CD14(+)CD16(+) monocytes, were negatively correlated with recovery of left ventricular ejection fraction 6 months after infarction. The peak levels of CD14(+)CD16(-) monocytes affect both the extent of myocardial salvage and the recovery of left ventricular function after AMI, indicating that the manipulation of monocyte heterogeneity could be a novel therapeutic target for salvaging ischemic damage.

Duration of Symptoms Is Not Always the Key Modulator of the Choice of Reperfusion for ST-Elevation Myocardial Infarction

Fibrinolytic therapy (FT) and primary percutaneous coronary intervention (PCI) are both well-accepted reperfusion therapies in ST-segment elevation myocardial infarction (STEMI). The evidence of randomized clinical trials indicates a relatively modest difference in 30-day mortality (≈1%) in favor of primary PCI over fibrin-specific FT and was based on very timely primary PCI (ie, a primary PCI–related delay of 40 minutes [door-to-balloon less door-to-needle time]).1 Longer delays to primary PCI, which are far more frequent in clinical practice,2 are associated with attenuated benefit or no benefit at all, particularly when compared with fibrin-specific FT.3,4 The benefit of timely primary PCI over FT is likely to especially apply to higher-risk patients.5,6 Irrespective of the method of reperfusion, the potential for myocardial salvage and better clinical outcome is inversely proportional to ischemic time or its only available clinical surrogate, symptom duration.7–12 These considerations underpin the notion expressed in the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the treatment of STEMI that timely reperfusion therapy is likely more important in determining outcome than whether FT or primary PCI is the chosen reperfusion method.13 Response by Armstrong et al p 1310 The ACC/AHA STEMI guidelines highlight the time point of 3 hours of symptom duration in guiding the choice of reperfusion therapy. They state that if symptom duration is <3 hours, no preference exists between FT and primary PCI provided that treatment is timely (for FT, door-to-needle time <30 minutes; for primary PCI, door-to-balloon time <90 minutes and ≤60 minutes between estimated needle time and estimated balloon time). However, if symptom duration exceeds 3 hours, these guidelines favor primary PCI over FT, again provided that primary PCI can be performed in a timely fashion.13 This article reexamines the evidence that may or may not be the basis …

Abstract 2404: ECG Estimate Of Ischemic Acuteness and Time from Pain Onset for Predicting Myocardial Salvage in Patients Undergoing Primary Percutaneous Coronary Intervention

Background: The potential for salvage of jeopardized myocardium during coronary occlusion decreases as the duration of persistent ischemia is prolonged. Thus, it is important to be able to assess the acuteness of ischemia as a patient presents with signs of acute coronary syndrome. The aim of this study was to compare ECG estimate of ischemic acuteness and time from pain onset for predicting myocardial salvage in patients with first-time myocardial infarction (MI). Methods: Thirteen patients with acutely revascularized first-time MI were studied. All patients had 99mTc tetrofosmin injected and an ECG recorded prior to the PCI. TIMI III flow was obtained in all patients. Single photon emission computed tomography (SPECT) was undertaken within 3 hours of the PCI to assess the myocardium at risk (MaR). Delayed contrast-enhanced magnetic resonance imaging (DE-MRI) was performed 1 week after admission for assessment of infarct size (IS) and infarct transmurality (IT). A salvage index was calculated as (MaR-IS)/MaR. The acuteness of ischemia was estimated both from patient history and from the Anderson-Wilkins (AW) acuteness score of the pre-PCI ECG. Results: The figure shows the relationship between time of symptom onset and salvage index (A) and IT (C) as well as the relationship between AW acuteness score and salvage index (B) and IT (D). The time of symptom onset did not correlate with salvage index or IT. The AW acuteness score, however, showed a significant relationship with both salvage index and IT. Conclusions: The initial ECG changes are superior to time from symptom onset to PCI for predicting myocardial salvage and IT in patients undergoing PCI of first-time MI.

Ability of mechanical reperfusion to salvage myocardium in patients with acute myocardial infarction presenting beyond 12 hours after onset of symptoms

The ability of primary percutaneous coronary intervention (PCI) to salvage myocardium in patients with acute ST-segment elevation myocardial infarction (STEMI) presenting >12 hours after symptom onset is questionable. The aim of this study was to assess the ability of primary PCI to salvage myocardium in patients with STEMI presenting between 12 and 48 hours after the symptom onset. In the BRAVE-2 trial, 365 patients with acute STEMI presenting between 12 and 48 hours from the symptom onset were randomized to an invasive (PCI) or a conservative treatment strategy. Two-hundred sixty-one patients enrolled in 2 centers had scintigraphy before randomization and 5 to 10 days later and constitute the cohort of the present study. Salvage index (proportion of initial perfusion defect salvaged) was the primary end point of this study. There were 131 patients randomly assigned to the invasive treatment and 130 patients assigned to the conservative treatment. Initial perfusion defect (median [25th-75th percentiles]) did not differ between groups (17.0% [9.0-28.5] vs 16.0% [9.0-37.5] of the left ventricle; P = .99). The final infarct size, measured in the follow-up scintigraphy, was significantly smaller in patients assigned to the invasive treatment than in those assigned to the conservative treatment (8.0% [2.0-16.0] vs 12.0% [3.2-25.0] of the left ventricle; P = .004). Salvage index was 0.44 (0.13-0.80) in the invasive group versus 0.23 (0.0-0.50) in the conservative group (P < .001). Primary PCI leads to significant myocardial salvage in patients with STEMI presenting between 12 and 48 hours after symptom onset.

Impact of Early Tirofiban Administration on Myocardial Salvage in Patients with Acute Myocardial Infarction Undergoing Infarct-Related Artery Stenting

Background/Aims: The timing of GpIIb/IIIa inhibitor administration may be important in achieving early epicardial and myocardial reperfusion. We evaluated the effect of early tirofiban on myocardial salvage and cardiovascular outcome in patients with acute myocardial infarction (AMI) undergoing infarct-related artery stenting. Methods: Patients (n = 66) with a first AMI presenting <6 h from onset of symptoms were randomized to either early administration of tirofiban in the emergency room (n = 32) or later administration in the catheterization laboratory (n = 34) (tirofiban bolus dose of 10 µg/kg, followed by 0.15 µg/kg for 24 h). The primary end-point was the degree of myocardial salvage, determined by means of serial scintigraphic studies with technetium-99m sestamibi. Thirty-day major adverse cardiac events were also assessed. Results: There were no significant differences in patient characteristics or in their presentation. The mean door-to-balloon time was similar in both groups (43 ± 12 and 53 ± 9 min, p = 0.08). The early and late treatment groups received tirofiban 18 ± 4 and 52 ± 10 min after admission, respectively. Angiographic analysis revealed a higher initial frequency of TIMI grade 3 flow in the early group (31% vs. 12%, p = 0.04). Procedural success was achieved in all patients. Myocardial risk area were comparable between early and late treatment groups (35.6 ± 12.2% vs. 39.3 ± 14.0%, p = 0.6). Scintigraphic outcomes demonstrated a significant reduction in the final infarction size (11.8 ± 5.2% vs. 22.4 ± 6.2%, p = 0.01), and improvement in salvage index (0.68 ± 0.22 vs. 0.44 ± 0.18, p = 0.003) in favor of the early tirofiban group. The thirty-day composite end-point of death, recurrent MI or rehospitalization also favored the early group (6% early, 15% late, p = 0.06). Conclusion: Early tirofiban administration enhanced the degree of myocardial salvage and clinical outcome in patients with AMI undergoing infarct-related artery stenting.

The Impact of the Capability of Circulating Progenitor Cell to Differentiate on Myocardial Salvage in Patients With Primary Acute Myocardial Infarction

Circulating endothelial progenitor cells (EPCs) are known to be involved in vasculogenesis and mobilized after acute myocardial infarction (AMI). To test the hypothesis that the angiogenic function of EPCs affects post-myocardial infarction (MI) myocardial salvage, we evaluated the number and potential differentiation of EPCs and compared these data with clinical parameters 6 months after MI. Consecutive 51 patients (age, 61+/-8 years, mean+/-SD) with primary AMI who were successfully treated with stenting were enrolled. EPC identified as CD45low, CD34+, CD133+, and VEGFR2+ was quantified by a flow cytometry. The potential of EPCs to differentiate into endothelial cells (EPC differentiation) was also confirmed by the upregulation of CD31 and VEGFR2 after 7 days of culture. According to the proportion of EPC fraction, patients were divided into 2 groups (cut-off value=median). Although no difference was seen in myocardial damage shown by mean peak CK leakage and mean area at risk between the differentiated group (n=26) and nondifferentiated group (n=25), the number of attached cell was greater in differentiated group than in the nondifferentiated group (P=0.023). Left ventricular function and ischemic damaged area were assessed by scintigraphic images of (123)I-BMIPP in the acute phase and (99m)Tc-tetrofosmin in the chronic phase. We found that a greater increase in myocardial salvage (P=0.0091), decrease in end-systolic volume (P=0.012), and recovery of ejection fraction (P=0.011) occurred in the group with differentiated EPCs than in the nondifferentiated group. In patients with primary AMI, the capability of EPCs to differentiate influences the functional improvement and infarct size reduction, indicating that manipulation of EPCs could be a novel therapeutic target to salvage ischemic damage.

Myocardial salvage in patients with non–ST-elevation myocardial infarction determined by myocardial perfusion imaging

We compared acute and late myocardial perfusion imaging using technetium-99m isotopes in 69 patients who had non-ST-elevation myocardial infarction. Among these patients, we found that the ischemic risk area was often large (19% of the left ventricle), and that 67% had significant myocardial salvage, defined as a >25% decrease in risk area, which was associated with an improved ejection fraction.

A randomized evaluation of the effects of glucose-insulin-potassium infusion on myocardial salvage in patients with acute myocardial infarction treated with reperfusion therapy

Background Intravenous glucose-insulin-potassium (GIK) may have a positive metabolic influence in patients with acute myocardial infarction (AMI) who receive reperfusion therapy. The objective of this randomized trial was to assess for the first time whether GIK improves myocardial salvage in patients with AMI. Methods The Reevaluation of Intensified Venous Metabolic Support for Acute Infarct Size Limitation (REVIVAL) trial is a randomized, open-label study conducted among 312 patients with AMI. Patients were randomly assigned to either the GIK therapy group (n = 155) or the control group (n = 157). All patients were intended to receive reperfusion treatment, which was given in all but 5 patients (1.6%). The primary end point of the study was salvage index, measured as the proportion of initial perfusion defect (acute technetium-99m sestamibi scintigraphy) salvaged by therapy (follow-up scintigraphy performed after 7 to 14 days). Results The primary end point of the study, the salvage index, was in median 0.50 (25th, 75th percentiles: 0.18, 0.87) in the GIK group and 0.48 (25th, 75th percentiles: 0.27, 0.78) in the control group ( P = .96). By 6 months, the mortality rate was 5.8% in the GIK group and 6.4% in the control group ( P = .85; relative risk, 0.92; 95% CI, 0.37 to 2.26). Subgroup analyses showed that GIK therapy was associated with increased salvage index only among diabetic patients (mean difference, 0.19; 95% CI, 0.01 to 0.37). Conclusions The routine use of GIK therapy in patients with AMI is not associated with enhanced myocardial salvage. This therapy appears to improve myocardial salvage only among diabetic patients.

1003-87 Reperfusion time-dependent myocardial salvage in patients with acute myocardial infarction who undergo emergent percutaneous coronary intervention with distal protection device percuSurge

1003-87 Reperfusion time-dependent myocardial salvage in patients with acute myocardial infarction who undergo emergent percutaneous coronary intervention with distal protection device percuSurge

Relation of lateral ST-segment elevation pattern to myocardial salvage in patients with recanalized anterolateral acute myocardial infarction.

Although anterior acute myocardial infarction (AMI) with ST-segment elevation in lateral leads is associated with a poor prognosis, the significance of the pattern of lateral ST-segment elevation has not been examined. The aim of the study was to examine the relation of the pattern of lateral ST-segment elevation to myocardial reperfusion and infarct size in patients with AMI. We studied 111 patients who had a first AMI presenting with anterolateral ST-segment elevation and Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow of the left anterior descending coronary artery within 6 h from symptom onset. Patients were classified into two groups according to the pattern of lateral ST-segment elevation on the admission electrocardiogram: Group 1, 42 patients with equivalent or greater ST-segment elevation in lead I than in lead aVL, and Group 2, 69 patients with lesser ST-segment elevation in lead I in than in lead aVL. Left ventricular ejection fraction (LVEF) was measured by predischarge left ventriculography. There were no differences between the two groups in age, gender, time from onset to recanalization, culprit lesion, or collateral development. Group 1 patients had a higher probability of impaired myocardial reperfusion as indicated by a myocardial blush grade of 0 or 1 after recanalization, a higher peak creatine kinase level, and a lower LVEF than Group 2 patients (p = 0.0001, respectively). We conclude that equivalent or greater ST-segment elevation in lead I than in lead aVL is associated with impaired myocardial reperfusion and less myocardial salvage in patients with recanalized AMI who present with anterolateral ST-segment elevation on the admission electrocardiogram.

3650 Effects of antithrombotic agents followed by percutaneous coronary intervention on coronary microcirculation and myocardial salvage in patients with acute myocardial infarction

3650 Effects of antithrombotic agents followed by percutaneous coronary intervention on coronary microcirculation and myocardial salvage in patients with acute myocardial infarction

Thrombolysis in myocardial infarction myocardial perfusion grade in angiography correlates with myocardial salvage in patients with acute myocardial infarction treated with stenting or thrombolysis

ObjectivesWe sought to assess the relationship between the Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion (TMP) grade and myocardial salvage as well as the usefulness of TMP grade in comparing two different reperfusion strategies. BackgroundThe angiographic index of TMP grade correlates with infarct size and mortality after thrombolysis for acute myocardial infarction (AMI). Its relationship to myocardial salvage and its usefulness in comparing different reperfusion strategies are not known. MethodsWe analyzed the TMP grade on angiograms obtained at one to two weeks after treatment in 267 patients enrolled in two randomized trials that compared stenting with thrombolysis in AMI. Patients were classified into two groups: 159 patients with TMP grade 2/3 and 108 patients with TMP grade 0/1. Two scintigraphic studies were performed: before and one to two weeks after reperfusion. The salvage index was calculated as the proportion of the area at risk salvaged by reperfusion. ResultsPatients with TMP grade 2/3 had a higher salvage index (0.49 ± 0.42 vs. 0.34 ± 0.49, p = 0.01), a smaller final infarct size (15.4 ± 15.5% vs. 22.1 ± 16.2% of the left ventricle, p = 0.001), and a trend toward lower one-year mortality (3.8% vs. 8.3%, p = 0.11) than patients with TMP grade 0/1. The relationship between TMP and salvage index was independent of the form of reperfusion therapy. The proportion of patients with TMP grade 2/3 was significantly higher after stenting than after thrombolysis (70.9% vs. 48.1%, p = 0.001). ConclusionsThese findings show that the TMP grade is a useful marker of the degree of myocardial salvage achieved with reperfusion and a sensitive indicator of the efficacy of reperfusion strategies in patients with AMI.

PIA polymorphism and myocardial salvage in patients with acute myocardial infarction treated with stenting or thrombolysis

PIA polymorphism and myocardial salvage in patients with acute myocardial infarction treated with stenting or thrombolysis

Rapid sealing of coronary perforations using polytetrafluoroethylene-covered stents

that the benefit of stenting plus abciximab is not restricted to patients with anterior wall AMI, but is also present in patients with nonanterior wall AMI. Stenting plus abciximab salvaged approximately 50% to 60% of the myocardium at risk regardless of the AMI location, whereas the relative salvage was only about 25% to 35% in patients randomized to thrombolysis. The increase in salvaged myocardium with stenting plus abciximab resulted in significantly smaller infarct sizes regardless of infarct location. Furthermore, although the 2 trials were not designed to evaluate the effect of stenting plus abciximab on survival, the AMI-free survival at 1 year was significantly improved in patients with anterior wall AMI, and there was also a clear trend in patients with nonanterior wall AMI. This obvious trend in patients with nonanterior wall AMI is not surprising taking into account the 58% increase in myocardial salvage and the 29% decrease in final infarct size associated with stenting. In conclusion, this analysis of the STOPAMI 1 and 2 trials demonstrates that stenting plus abciximab compared with thrombolysis with or without concomitant abciximab results in a significantly increased myocardial salvage in patients with anterior wall as well as nonanterior wall AMI. In patients with nonanterior wall AMI, increased myocardial salvage associated with stenting is expected to translate into a survival advantage that needs to be confirmed by larger trials.

Impact of acute myocardial infarct location on myocardial salvage after stenting or thrombolysis (results from the STOPAMI 1 and 2 trials): Stent versus Thrombolysis for Occluded coronary arteries in Patients with Acute Myocardial Infarction

In the Stent versus Thrombolysis for Occluded coronary arteries in Patients with Acute Myocardial Infarction (STOPAMI 1 and 2) trials,1,2 we demonstrated that the myocardial salvage in patients with acute myocardial infarction (AMI) is significantly improved by stenting plus abciximab compared with thrombolysis with or without concomitant abciximab administration. The rationale of this prespecified analysis of the combined patient cohorts of STOPAMI 1 and 2 was to investigate whether the benefit of current reperfusion strategies is dependent on infarct location.

Effect of abciximab on myocardial salvage in patients with acute myocardial infarction undergoing primary angioplasty

Effect of abciximab on myocardial salvage in patients with acute myocardial infarction undergoing primary angioplasty

Reliability of resolution of ST-segment elevation after coronary reperfusion in predicting myocardial salvage in anterior wall acute myocardial infarction

Resolution of ST-segment elevation (ST resolution) after reperfusion therapy has been shown to correlate with improved left ventricular (LV) function in patients with acute myocardial infarction (AMI). However, not all patients with ST resolution have preserved LV function. We evaluated the clinical significance of ST resolution in 129 patients with anterior wall AMI who underwent successful coronary recanalization within 6 hours after symptom onset by studying the relation to myocardial blush grade, another angiographic marker of myocardial reperfusion. A reduction of ≥50% in ST-segment elevation after recanalization was defined as ST resolution. Ninety-eight patients had ST resolution and 31 patients did not. Patients with ST resolution were subdivided into 2 groups according to myocardial blush grade after recanalization: 67 patients with blush grade 2 or 3, and 31 with blush grade 0 or 1. The QRS score after recanalization was higher (5.9 ± 1.9 vs 3.4 ± 2.0, p <0.01) and predischarge LV ejection fraction was lower (39 ± 8% vs 57 ± 9%, p <0.01) in patients with blush grade 0 or 1 than in those with blush grade 2 or 3. However, the QRS score after recanalization and the predischarge LV ejection fraction were similar in patients who had ST resolution with blush grade 0 or 1 and in those without ST resolution. Our findings suggest that ST resolution after recanalization does not consistently predict myocardial salvage in patients with anterior AMI.