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re-elevation, despite initial ST resolution, occurred in 23% of the patients, and was associated with poorer EF at 6 months. They divided their patients into 3 groups (ST resolution without re-elevation, ST resolution with reelevation, and no ST resolution), and showed the serial ECG changes (Figure). In this issue of the Journal, Cuenin et al8 report that 19% of 662 patients experienced ST segment re-elevation, but there were no differences in EF or death at 1 year between patients with and without re-elevation. Although the incidence of ST re-elevation was similar to that reported by Okuda et al, the effect on EF was inconsistent. Several differences between the 2 studies may have influenced the results. First, the timing of evaluation for ST re-elevation was different. Most previous studies evaluated ST resolution within several hours after reperfusion therapy, and ST resolution was consistently associated with better clinical outcomes. The mechanism of ST re-elevation is unclear and its occurrence suggests the possibility of re-infarction or pericarditis. In fact, stent P rimary percutaneous coronary intervention (PCI) to recanalize an occluded artery has been the main treatment for acute myocardial infarction (AMI), but a substantial number of patients still develop large infarcts. Impaired microvascular reperfusion, which is evaluated by the absence of resolution of ST-segment elevation (ST resolution) on the 12-lead ECG following reperfusion therapy, is considered to be associated with worse final TIMI (Thrombolysis in Myocardial Infarction) flow grade and large infarcts.1 Furthermore, the measure of ST resolution has been reported to correlate with left ventricular function, survival, and reinfarction during longterm follow-up after both primary PCI and thrombolytic therapy.1–7 ST resolution occurs in 64–85% of patients, as shown in the Table. Only a few previous reports have investigated the prevalence of ST segment re-elevation even though ECG is a standard and simple diagnostic modality. Matano et al reported that ST re-elevation occurred in 29% of the patients, but that there was no difference in ejection fraction (EF) at 1 month between the patients with and without ST re-elevation.4 In contrast, Okuda et al6 reported that ST Article p 1379

Is There Any Impact of ST Re-elevation on Patients With Acute Myocardial Infarction Following Reperfusion Therapy?