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Intracoronary ECG ST‐segment recovery during primary percutaneous intervention for ST‐segment myocardial infarction: Insights from a cardiac MRI study
Author(s) -
Wong Dennis T.L.,
Leung Michael C.H.,
Das Rajiv,
Puri Rishi,
Liew Gary Y.H.,
Teo Karen S.L.,
Chew Derek P.,
Meredith Ian T.,
Worthley Matthew I.,
Worthley Stephen G.
Publication year - 2012
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.23455
Subject(s) - medicine , cardiology , timi , myocardial infarction , st segment , percutaneous coronary intervention , conventional pci , ejection fraction , electrocardiography , cardiac magnetic resonance imaging , st elevation , magnetic resonance imaging , radiology , heart failure
Background ST‐segment‐resolution (STR) on surface electrocardiogram (ECG) is a good surrogate for myocardial reperfusion in patients with acute ST‐segment‐elevation‐myocardial‐infarction (STEMI). We sort to determine the optimal criteria of measuring STR on intracoronary‐ECG (IC‐ECG) for prediction of myocardial injury evaluated by cardiac MRI (CMR). Methods Measurements of IC‐ECG ST‐segments were performed at baseline, immediately after (early) and 15 min (late) after achieving TIMI‐3 flow during primary‐PCI. The degree of ST‐segment‐shift from baseline noted upon the IC‐ECG was divided into four groups: (group 1) ST‐segment‐resolution >1 mm, (group 2) <30% resolution, (group 3) >50% resolution, (group 4) >70% resolution at both early and late time points. Patients had CMR at days 3 and 90 postprimary‐PCI. Results Fifty two patients (aged 60 ± 11 years; 43 males) were evaluated. Early intracoronary‐ECG ST‐segment resolution (early IC‐STR >1 mm) correlated with smaller scar mass ( P = 0.003), nonviable myocardial mass ( P < 0.001), and microvascular obstruction (MVO) ( P = 0.004) on CMR at day 3. Ejection fraction (EF) was also better at day 3 ( P = 0.026) and 90 ( P = 0.039). Patients with poor early IC‐STR (IC‐STR <30%) conversely is associated with larger scar mass ( P = 0.017), nonviable myocardial mass ( P = 0.01), and MVO ( P = 0.021) at day 3. This was also associated with worse EF at day 90 ( P = 0.044). Neither group 3 or 4, or the late measurements of late IC‐STR correlated with CMR markers of myocardial injury. Conclusion The degree of early IC‐STR (defined by IC‐STR > 1 mm or <30%) successfully predicts myocardial damage following primary‐PCI for an acute STEMI. Further studies are required to investigate its potential utility. © 2011 Wiley Periodicals, Inc.