Early Resolution of ST-Segment Elevation Correlates With Myocardial Salvage Assessed by Tc-99m Sestamibi Scintigraphy in Patients With Acute Myocardial Infarction After Mechanical or Thrombolytic Reperfusion Therapy
Open Access
- 25 June 2002
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 105 (25), 2946-2949
- https://doi.org/10.1161/01.cir.0000022604.56986.ff
Abstract
Background — Early resolution of ST-segment elevation is an indicator of final infarct size and clinical outcomes. Whether this correlation is an expression of initial infarct characteristics or degree of myocardial salvage achieved with reperfusion therapy is unclear. Methods and Results — We prospectively included 243 patients with acute myocardial infarction (AMI) treated with either coronary stenting (122 patients) or thrombolysis (121 patients). Serial 12-lead electrocardiograms (ECG) were performed at baseline and 90 minutes after initiation of therapy. ST-segment resolution was defined as complete (≥70%), partial (P =0.008), final infarct size ( P P =0.03). In the groups with complete, partial, and no resolution, salvage index was 0.54±0.32, 0.39±0.36, and 0.33±0.60; final infarct size was 12.5±12.0%, 20.0±13.9%, and 22.7±19.4% of the left ventricle; 6-month mortality was 2.4%, 6.2%, and 12.8%, respectively. After adjustment for baseline characteristics, ST-segment resolution was the second strongest predictor of salvage index ( P =0.007) after the type of reperfusion, stenting, or thrombolysis ( P =0.001); it was greater after stenting than after thrombolysis ( P Conclusion — Early resolution of ST-segment elevation in surface ECG correlates with myocardial salvage as assessed by scintigraphy in patients with AMI after reperfusion therapy. These data provide an explanation for the favorable prognostic value of the ST-segment resolution and support the use of this parameter to compare the efficacy of different reperfusion strategies.Keywords
This publication has 10 references indexed in Scilit:
- Myocardial salvage after coronary stenting plus abciximab versus fibrinolysis plus abciximab in patients with acute myocardial infarction: a randomised trialThe Lancet, 2002
- Extent of ST-segment deviation in a single electrocardiogram lead 90 min after thrombolysis as a predictor of medium-term mortality in acute myocardial infarctionThe Lancet, 2001
- ST segment resolution as a tool for assessing the efficacy of reperfusion therapyJournal of the American College of Cardiology, 2001
- Coronary Stenting plus Platelet Glycoprotein IIb/IIIa Blockade Compared with Tissue Plasminogen Activator in Acute Myocardial InfarctionThe New England Journal of Medicine, 2000
- Angiographic and scintigraphic (perfusion and electrocardiogram-gated spect) correlates of clinical presentation in unstable anginaClinical Cardiology, 2000
- Abciximab Improves Both Epicardial Flow and Myocardial Reperfusion in ST-Elevation Myocardial InfarctionCirculation, 2000
- Infarct Size Measured by Single Photon Emission Computed Tomographic Imaging With 99m Tc-SestamibiCirculation, 2000
- The distinction between coronary and myocardial reperfusion after thrombolytic therapy by clinical markers of reperfusionJournal of the American College of Cardiology, 1998
- Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarctionThe Lancet, 1997
- Prognostic Markers in Thrombolytic Therapy: Looking Beyond MortalityThe American Journal of Cardiology, 1996