Coronary Artery Diseases
Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty

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Abstract

The aim of this study was to evaluate the relation between myocardial perfusion and ST-segment changes in patients with acute myocardial infarction treated with successful direct angioplasty. Thirty-seven patients, successfully treated with direct angioplasty, underwent myocardial contrast echocardiography before and after angioplasty. The sum of ST-segment elevation divided by the number of the leads involved (ST-segment elevation index) was calculated at 1, 5, 10, 20, and 30 minutes after restoration of a Thrombolysis In Myocardial Infarction trial grade 3 flow. After recanalization, myocardial reperfusion within the risk area was observed in 26 patients, whereas a no-reflow phenomenon occurred in 11. In patients with myocardial reperfusion, the ST-segment elevation index progressively declined, whereas in patients with no reflow, no significant change was observed. Reduction of ≥50% in the ST-segment elevation index occurred in 20 of the 26 patients with reflow and in 1 of the 11 with no reflow (p = 0.0002). An additional increase of ≥30% in the ST-segment elevation index occurred in 3 patients with reflow and in 7 with no reflow (p = 0.003). Sensitivity, specificity, positive and negative predictive values, and accuracy of the reduction in the ST-segment elevation index for predicting microvascular reflow were 77%, 91%, 95%, 62%, and 81%, respectively. The corresponding values of the increase in ST-segment elevation index for predicting no reflow were 64%, 88%, 70%, 85%, and 81%, respectively. In conclusion, after successful angioplasty, different patterns of myocardial perfusion are associated with different ST-segment changes. Analysis of ST-segment changes predicts the degree of myocardial reperfusion.

Section snippets

Patients and study protocol

We prospectively studied 42 patients with acute myocardial infarction referred to the catheterization laboratory of our department for emergency direct coronary angioplasty. They fulfilled the following inclusion criteria: (1) presentation within 6 hours of the onset of symptoms; (2) successful recanalization of an initially occluded infarct artery (TIMI grade 0 to 1 flow) with restoration of a TIMI grade 3 flow; (3) absence of conditions precluding the evaluation of ST-segment changes in the

Perfusion patterns and patient characteristics

Before coronary angioplasty a myocardial perfusion defect was observed in all patients. After the end of angioplasty, MCE showed recovery of perfusion in 26 patients and no-reflow phenomenon in 11 patients. Patient characteristics in the 2 groups are listed in Table I. There were no significant differences in the following: age, gender, history of angina or myocardial infarction, time from symptom onset to admission, involvement of left anterior descending artery as infarct artery, prevalence

Myocardial perfusion and ST-segment changes

To our knowledge, this is the first study with the goal of assessing the relation between myocardial perfusion and ST-segment changes at reperfusion. The major finding is that after successful coronary angioplasty, different patterns of myocardial perfusion are associated with different ST-segment changes. A rapid decrease in ΣSTI was observed in the group of patients with myocardial reperfusion, whereas in the group with no-reflow phenomenon, no significant change occurred. Because ΣSTI

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