ACUTE CORONARY SYNDROMES

Functional and structural correlates of persistent ST elevation after acute myocardial infarction successfully treated by percutaneous coronary intervention

Leonarda Galiuto¹, Sabrina Barchetta¹, Serena Paladini², Gaetano Lanza¹, Antonio G Rebuzzi¹, Mario Marzilli², Filippo Crea¹

¹ Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
² Institute of Cardiology, University of Siena, Siena, Italy

Dr L Galiuto, Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Largo A. Gemelli, 8, 00168 Rome, Italy; lgaliuto{at}rm.unicatt.it

Background: In the thrombolytic era, persistence of ST-segment elevation was considered a marker of left ventricular (LV) aneurysm. ST-segment elevation may still be found persistently raised after successful primary percutaneous coronary intervention (PCI). Echocardiographic correlates of this finding, however, are still poorly known.

Methods and results: 82 consecutive patients with first ST-segment elevation myocardial infarction and successful PCI were divided into patients with persistent ST-segment elevation at discharge (sum of ST >4 mm) (n = 33) and those without persistent ST-segment elevation (n = 49). Conventional and myocardial contrast echocardiography were performed at discharge and at 6 months. At discharge, LV aneurysm was more common in patients with persistent ST elevation (27% vs 8%, p<0.005). Similarly, the wall motion score index was higher (2.5 vs 2.0, p<0.005) and microvascular damage larger (2.3 vs 1.8, p<0.005) in patients with persistent ST-segment elevation. At 6 months’ follow-up, LV volumes were similar in the two groups.

Conclusions: After primary PCI, persistent ST-segment elevation is associated with LV aneurysm formation in 30% of cases, it is not associated with significantly larger LV dilatation but with larger microvascular damage and dysfunctioning risk area.

Abbreviations: AMI, acute myocardial infarction; CDL, contrast defect length; CK, creatine kinase; CSI, contrast score index; LV, left ventricular; MCE, myocardial contrast echocardiography; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; TIMI, Thrombolysis In Myocardial Infarction

Keywords: microvascular dysfunction; microcirculation; myocardial infarction

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