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Early identification of impaired myocardial reperfusion with serial assessment of ST segments after percutaneous transluminal coronary angioplasty during acute myocardial infarction

Authors :
Kengo Hatada
Daiki Saito
Seishi Nakamura
Toshiji Iwasaka
Shinichi Hamada
Junko Watanabe
Tetsuro Sugiura
Hironori Miyoshi
Kazuya Takehana
Masato Baden
Hirohiko Kurihara
Source :
The American journal of cardiology. 88(9)
Publication Year :
2001

Abstract

To evaluate the relation between ST-segment analysis and microvascular reperfusion in patients with acute myocardial infarction (AMI), we studied 51 patients with first AMI who were successfully treated by percutaneous transluminal coronary angioplasty (PTCA). The lead showing the greatest ST-segment elevation on the 12-lead electrocardiogram (ECG) was serially investigated until 24 hours after PTCA. Successful reperfusion was determined by technetium-99m tetrofosmin single-photon emission computed tomography. Impaired reperfusion (group 1:4 change in the sum of the defect score from before to immediately after PTCA) was observed in 24 patients, and successful reperfusion (group 2) was observed in 27 patients. Although ST-segment elevation was reduced significantly at 30 minutes after PTCA in group 2 (2.2 +/- 1.4 to 1.7 +/- 1.3 mm, p = 0.01), there was no significant change in group 1 (1.9 +/- 1.9 to 2.4 +/- 1.7 mm). Ten of 14 patients (71%) with persistent ST-segment elevation (DeltaST0 mm change in ST segment from before to 30 minutes after PTCA0) were in group 1, whereas 23 of 37 patients (62%) with ST-segment resolution (DeltaSTor = 0) were in group 2. The sensitivity and specificity of persistent ST-segment elevation for predicting impaired microvascular reperfusion were 42% and 85%, respectively. Thus, persistent ST-segment elevation 30 minutes after primary PTCA was a highly specific electrocardiographic marker of impaired reperfusion in patients with AMI.

Details

ISSN :
00029149
Volume :
88
Issue :
9
Database :
OpenAIRE
Journal :
The American journal of cardiology
Accession number :
edsair.doi.dedup.....aeb0d6a48e718ec37459dcdfc843dea2