Document Detail


Early electrocardiographic findings and MR imaging-verified microvascular injury and myocardial infarct size.
MedLine Citation:
PMID:  19833308     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study investigated early electrocardiographic findings in relation to left ventricular (LV) function, extent and size of infarction, and microvascular injury in patients with acute myocardial infarction (MI) treated with percutaneous coronary intervention (PCI). BACKGROUND: The electrocardiogram (ECG) is the most used and simplest clinical method to evaluate the risk for patients immediately after reperfusion therapy for acute MI. ST-segment resolution and residual ST-segment elevation have been used for prognosis in acute MI, whereas Q waves are related to outcome in chronic MI. We hypothesized that the combination of these electrocardiographic measures early after primary PCI would enhance risk stratification. METHODS: We prospectively included 180 patients with a first acute ST-segment elevation MI to assess ST-segment resolution, residual ST-segment elevation, and number of Q waves using the 12-lead ECG acquired on admission and 1 h after successful PCI. The ECG findings were related to LV function, infarction size and transmurality, and microvascular injury as assessed with cine and gadolinium-enhanced cardiac magnetic resonance 4 +/- 2 days after reperfusion therapy. RESULTS: Residual ST-segment elevation (beta = -2.00, p = 0.004) and the number of Q waves (beta = -1.66, p = 0.005) were independent ECG predictors of LV ejection fraction. Although the number of Q waves was the only independent predictor of infarct size (beta = 2.01, p < 0.001) and transmural extent of infarction (beta = 0.60, p < 0.001), residual ST-segment elevation was the only independent predictor of microvascular injury (odds ratio: 19.1, 95% confidence interval: 2.4 to 154, p = 0.005) in multivariable analyses. The ST-segment resolution was neither associated with LV function, infarct size, or transmurality indexes, nor with microvascular injury in multivariable analysis. CONCLUSIONS: In patients after successful coronary intervention for acute MI, residual ST-segment elevation and the number of Q waves on the post-procedural ECG offer valuable complementary information on prediction of myocardial function and necrosis and its microvascular status.
Authors:
Robin Nijveldt; Pieter A van der Vleuten; Alexander Hirsch; Aernout M Beek; Ren?? A Tio; Jan G P Tijssen; Jan J Piek; Albert C van Rossum; Felix Zijlstra
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  2     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2010-01-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1187-94     Citation Subset:  IM    
Affiliation:
Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. r.nijveldt@vumc.nl
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects
Contrast Media / diagnostic use
Coronary Angiography
Coronary Vessels / pathology*
Electrocardiography*
Female
Humans
Linear Models
Logistic Models
Magnetic Resonance Imaging, Cine*
Male
Meglumine / diagnostic use
Microvessels / pathology
Middle Aged
Myocardial Infarction / diagnosis*,  pathology,  physiopathology,  therapy*
Myocardium / pathology*
Necrosis
Odds Ratio
Organometallic Compounds / diagnostic use
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Organometallic Compounds; 0/gadoterate meglumine; 6284-40-8/Meglumine
Comments/Corrections
Comment In:
JACC Cardiovasc Imaging. 2009 Oct;2(10):1195-7   [PMID:  19833309 ]

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