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Acute coronary syndromes
Functional and structural correlates of persistent ST elevation after acute myocardial infarction successfully treated by percutaneous coronary intervention
  1. Leonarda Galiuto1,
  2. Sabrina Barchetta1,
  3. Serena Paladini2,
  4. Gaetano Lanza1,
  5. Antonio G Rebuzzi1,
  6. Mario Marzilli2,
  7. Filippo Crea1
  1. 1
    Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
  2. 2
    Institute of Cardiology, University of Siena, Siena, Italy
  1. 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

Abstract

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.

  • microvascular dysfunction
  • microcirculation
  • myocardial infarction

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Footnotes

  • Conflict of interest: None.

  • 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

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