ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling.

Introduction: Spontaneous recanalization of the infarct-related artery (IRA) in ST-segment elevation myocardial infarction (STEMI) before primary angioplasty (PCI) improves clinical outcomes.
Aim: To investigate the impact of ST-segment re-elevation (reSTE) following PCI in patent IRA on left ventricular (LV) function recovery and remodeling.
Material and Methods: Of 155 STEMI patients with patent IRA, 19 (12.3%) patients with TIMI-2 (T2 _Res ) and 85 (54.8%) with TIMI-3 (T3 _Res ) had further STE resolution following PCI, 20 (12.9%) with TIMI-3 did not require PCI (T3 _noPCI ) and 31 (20.0%) with TIMI-2/3 had reSTE of ≥ 1 mm following PCI as compared with pre-PCI recordings (T23 _reSTE ). LV ejection fraction (LVEF, %) and LV end-diastolic and end-systolic volume indexes (LVEDVI, LVESVI, ml/m ² ) were measured by echocardiography 2 days and 6 months following PCI.
Results: In 6-month observation the improvement of LVEF in T3 _Res (by 3.9 ±5.1%) and in T3 _noPCI (by 5.7 ±6.1%) patients was higher as compared with T23 _reSTE (0.2 ±7.0%, p < 0.05 versus both). LVEDVI increased in T23 _reSTE patients by 6.6 ±12.6 ml/m ² , but decreased in T3 _Res by 3.8 ±9.7 ml/m ² and in T3 _noPCI by 2.4 ±6.2 ml/m ² (for both p < 0.05 vs. T23 _reSTE ). LVESVI increased in T23 _reSTE patients (by 3.8 ±10.8 ml/m ² ), did not change in T2 _Res (by 0.1 ±9.0 ml/m ² ), but decreased in T3 _Res (by 4.2 ±7.2 ml/m ² , p < 0.05 vs. T23 _reSTE ) and in T3 _noPCI patients (by 4.7 ±7.7 ml/m ² , p < 0.05 vs. T23 _reSTE ). ReSTE was an independent predictor of LVEF, LVEDVI and LVESVI changes ( p < 0.001 for all).
Conclusions: ReSTE following PCI in a patent IRA is associated with a lack of improvement of LV contractility and subsequent LV remodeling.
Competing Interests: The authors declare no conflict of interest.
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