ST-Segment Analysis to Predict Infarct Size and Functional Outcome in Acute Myocardial Infarction Treated With Primary Coronary Intervention and Adjunctive Abciximab Therapy

Abstract

ST-segment resolution is used to classify the response to reperfusion therapy in acute myocardial infarction, but the possibility to predict outcome in individual patients is unclear, particularly in the setting of primary percutaneous coronary intervention (PCI) and abciximab therapy. We studied 213 patients who underwent successful revascularization with PCI. Maximal ST-segment elevation was measured before and 30 minutes after PCI. Patient outcome was defined on the basis of infarct size and left ventricular ejection fraction (EF) as derived from gated single-photon emission computed tomography that was acquired 1 month after infarction. . Using receiver-operating characteristic curve analysis, the optimal ST-resolution cutoff was >60%, with 77% sensitivity and 51% specificity for predicting favorable outcome. ST-segment elevation <4.5 mV before PCI was 80% sensitive and 48% specific, and ST-segment elevation <1 mV after PCI was 74% sensitive and 60% specific for predicting favorable outcome. Early decrease of ST-segment elevation has been demonstrated to be a marker of myocardial tissue level reperfusion and thus of revascularization success. [1][2][3][4] The prognostic implications of this marker in patients who have acute myocardial infarction are known. [1][2][3]5 Other studies have suggested a relation between ST-segment resolution and infarct size and/or postinfarction left ventricular function, but the usefulness of ST-segment changes for predicting infarct extent and severity in the patient population has been questioned. 6 -10 In recent years, important advances in the treatment of infarction have been introduced and an aggressive therapy, based on direct percutaneous coronary intervention (PCI) with stenting plus abciximab administration, is currently the most advanced approach to infarct treatment. 11-14 Although ST-segment resolution has been used to test these new therapeutic strategies, its relation to objective parameters of treatment results in the patient population has not been examined. This study evaluated the accuracy of the simplest and quickest approach to ST-segment elevation analysis, i.e., single-lead analysis before and 30 minutes after PCI, 4 in characterizing the outcome of patients with acute myocardial infarction and who underwent early PCI with direct stenting and adjunctive abciximab therapy, using as the reference 1-month scintigraphic infarct size and left ventricular ejection fraction (EF). MethodsStudy patients: Between January 2001 and September 2004, 213 consecutive patients (155 men; mean 65 Ϯ 12 years of age) who had acute myocardial infarction and underwent primary PCI with direct stenting and adjunctive abciximab therapy were studied at 1 month after the index infarction for the assessment of myocardial perfusion and left ventricular function with gated single-photon emission computed tomography. Inclusion criteria were chest pain that persisted Ͼ30 minutes and was associated with STsegment elevation Ն0.1 mV in Ն2 contiguous electrocardiographic leads, admission wit...

The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Known Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling

“…Similarly, Poli et al (15) showed no additional predictive value of ST-segment resolution when summed to MBG with respect to 6-month functional recovery. Finally, Sciagrà et al (17) found, in the setting of patients who were treated with primary stenting and abciximab, a relatively low correlation between ST-segment resolution and infarct size and EF, suggesting the use of ECG findings only to categorize outcome as favorable or unfavorable but not to assess infarct size or LV function. In this multicenter study, we confirm and highlight the weak correlation between ST-segment resolution and EF and WMSI at 6-month follow-up, and we demonstrate that this ECG parameter is not able to predict post-infarct LV remodeling.…”

Impact of hypertension on infarct size in ST elevation myocardial infarction patients undergoing primary angioplasty

“…However, even though primary angioplasty has been shown to provide larger benefits as compared with thrombolysis, a suboptimal myocardial reperfusion is observed in a still relevant proportion of patients, despite optimal epicardial recanalization [7][8][9]. Hypertension is an established risk factor for atherosclerosis [10].…”

ST peak during primary percutaneous coronary intervention predicts final infarct size, left ventricular function, and clinical outcome

“…To identify the independent association of ST peak with infarct size and LVEF, multivariable regression analyses were performed using ST peak and known predictors of infarct size and LVEF such as anterior infarct location, symptoms-to-balloon time, preprocedural TIMI flow, baseline ST elevation (in millimeters), and ST resolution (30, 60, and 90 minutes after reperfusion). 32,33 Because of expected colinearity between ST resolutions after 30, 60, and 90 minutes, respectively, only the best of the 3 in the univariable analyses was used in the multivariable approach. The potentially confounding effect of exenatide and IPost was evaluated by interaction between ST peak and exenatide/IPost treatment and by adjusting for exenatide/IPost vs conventional treatment in a linear regression analysis.…”