RT Journal Article
SR Electronic
T1 Prognostic significance and relationship of worst lead residual ST segment elevation with myocardial damage assessed by cardiovascular MRI in myocardial infarction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1257
OP 1263
DO 10.1136/heartjnl-2013-305462
VO 100
IS 16
A1 K P Rommel
A1 A Baum
A1 M Mende
A1 S Desch
A1 M Gutberlet
A1 G Schuler
A1 H Thiele
A1 I Eitel
YR 2014
UL http://heart.bmj.com/content/100/16/1257.abstract
AB Objective To investigate the relation of residual worst lead ST segment elevation (WL-STE) after ST segment myocardial infarction (STEMI) with infarct size and microvascular injury assessed by cardiovascular magnetic resonance (CMR) imaging. Background WL-STE in patients with acute reperfused STEMI has been shown to identify high risk patients for major adverse cardiovascular events (MACE). However, the relation of WL-STE with myocardial damage is unknown. Methods In this multicentre study we analysed ECG data 90 min after primary percutaneous coronary intervention (PCI) in 763 STEMI patients. WL-STE was defined as the absolute magnitude of STE in the most affected lead on the post-PCI ECG. Patients were categorised into three groups (<1 mm, 1–2 mm, and ≥2 mm). CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardised protocol. The primary clinical endpoint was MACE defined as death, reinfarction, and new congestive heart failure within 12 months after infarction. Results WL-STE <1 mm, 1–2 mm, and ≥2 mm was present in 155 (20%), 328 (43%), and 280 (37%) patients, respectively. Myocardial damage determined by CMR demonstrated a graded relationship of infarct size (median (IQR) 13.3 (6.2–20.3)%LV vs 13.7 (7.6–21.3)%LV vs 22.5 (15.6–31.2)%LV, p<0.001), the myocardial salvage index (60.8 (37.0–84.5) vs 55.0 (36.6–73.9) vs 42.7 (26.2–58.2), p<0.001), and microvascular obstruction (0.0 (0.0–0.9)%LV vs 0.0 (0–1.0)%LV vs 1.2 (0.0–3.6)%LV, p<0.001) across the three groups. WL-STE ≥2 mm was strongly associated with MACE 12 month after infarction (HR 1.93, 95% CI 1.11 to 3.37; p=0.02). Conclusions This largest CMR study to date correlating post-PCI WL-STE with markers of myocardial damage demonstrates that WL-STE is significantly associated with infarct size, myocardial salvage, microvascular obstruction, and MACE in a high risk STEMI population. Trial registration number NCT00712101.