CLINICAL STUDIES
The significance of persistent ST elevation versus early resolution of ST segment elevation after primary PTCA
Shlomi Matetzky, MDa,b,
Maxim Novikov, MDa,b,
Luis Gruberg, MDa,b,
Dov Freimark, MDa,b,
Micha Feinberg, MDa,b,
Dan Elian, MDa,b,
Ilya Novikov, PhDa,b,
Elio Di Segni, MDa,b,
Oren Agranat, MDa,b,
Yedael Har-Zahav, MDa,b,
Babeth Rabinowitz, MD, FACCa,b,
Elieser Kaplinsky, MD, FACCa,b and
Hanoch Hod, MD, FACCa,b
a Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
b Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Manuscript received December 31, 1998;
revised manuscript received June 15, 1999,
accepted September 1, 1999.
Reprint requests and correspondence: Dr. Hanoch Hod, Heart Institute, Sheba Medical Center, 52621 Tel Hashomer, Israel
babethr{at}post.tau.ac.il
OBJECTIVES
To determine the prevalence and clinical significance of early ST segment elevation resolution after primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI).
BACKGROUND
Despite angiographically successful restoration of coronary flow early during AMI, adequate myocardial reperfusion might not occur in a substantial portion of the jeopardized myocardium due to microvascular damage. This phenomenon comprises the potentially beneficial effect of early recanalization of the infarct related artery (IRA).
METHODS
Included in the study were 117 consecutive patients who underwent angiographically successful [Thrombolysis in Myocardial Infarction (TIMI III)] primary PTCA. The patients were classified based on the presence or absence of reduction  50% in ST segment elevation in an ECG performed immediately upon return to the intensive cardiac care unit after the PTCA in comparison with ECG before the intervention.
RESULTS
Eighty-nine patients (76%) had early ST segment elevation resolution (Group A) and 28 patients (24%) did not (Group B). Group A and B had similar clinical and hemodynamic features before referring to primary PTCA, as well as similar angiographic results. Despite this, ST segment elevation resolution was associated with better predischarge left ventricular ejection fraction (LVEF) (44.7 ± 8.0 vs. 38.2 ± 8.5, p < 0.01). Group B patients, as compared with those of Group A, had a higher incidence of in-hospital mortality (11% vs. 2%, p = 0.088), congestive heart failure (CHF) [28% vs. 19%, odds ratio (OR) = 4, 95% confidence interval (CI) 1 to 15, p = 0.04], higher long-term mortality (OR = 7.3, 95% CI 1.9 to 28, p = 0.004 with Cox proportional hazard regression analysis) and long-term CHF rate (OR = 6.5, 95% CI 1.3 to 33, p = 0.016 with logistic regression).
CONCLUSIONS
Absence of early ST segment elevation resolution after angiographically successful primary PTCA identifies patients who are less likely to benefit from the early restoration of flow in the IRA, probably because of microvascular damage and subsequently less myocardial salvage.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CAD | = coronary artery disease | | CHF | = congestive heart failure | | CK | = creatine kinase | | IABP | = intra-aortic balloon pulsation | | ICCU | = intensive cardiac care unit | | IRA | = infarct related artery | | LV | = left ventricle | | LVEF | = left ventricular ejection fraction | | MCE | = myocardial contrast echo | | PTCA | = percutaneous transluminal coronary angioplasty | | TIMI | = Thrombolysis in Myocardial Infarction |
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