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Intracoronary ECG during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction predicts microvascular obstruction and infarct size.
MedLine Citation:
PMID:  21875755     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: Microvascular obstruction (MVO) following ST-segment elevation myocardial infarction (STEMI) is associated with larger infarct size and an increased mortality. Although angiographic predictors of MVO in primary percutaneous coronary intervention (primary-PCI) setting have been identified, an earlier and objective "in-lab" predictor may be beneficial, in order to potentially influence therapies administered during primary-PCI. We hypothesised that intracoronary-electrocardiogram (IC-ECG) is a simple, objective and accurate predictor of MVO evaluated by cardiac magnetic resonance (CMR) and is comparable to myocardial blush grade (MBG) and TIMI myocardial perfusion grade (TMPG). METHOD: Intracoronary ECG was performed during primary-PCI. Intracoronary ST-segment measurement was performed before and immediately after opening of infarct-related-artery. Intracoronary ST-segment resolution (IC-STR) was defined as ≥1mm improvement compared to baseline. Contrast enhanced CMR was performed at 4 and 90days post primary-PCI. Primary endpoint was MVO on late gadolinium hyperenhancement assessed by CMR at day 4. RESULTS: Sixty-four consecutive patients (age 59±11years; 55 males) were recruited. Intracoronary ST-segment resolution correlated with MVO (p=0.005). Furthermore, IC-STR correlated with infarct-mass, non-viable-mass, peak creatinine kinase and end-systolic-volume at day 4. Intracoronary ST-segment resolution also correlated with favourable left ventricular end-diastolic-volume at day 90 (p=0.022). On multivariate analysis, IC-STR was an independent predictor of MVO. CONCLUSION: Intracoronary ST-segment resolution is a strong in-lab predictor of MVO assessed 4days after STEMI on CMR. Furthermore, IC-STR correlates with infarct size and left ventricular remodelling at 3months. Further studies are required to understand potential clinical utility of this tool.
Authors:
Dennis T L Wong; Michael C H Leung; Rajiv Das; Gary Y H Liew; Karen S L Teo; Derek P Chew; Ian T Meredith; Matthew I Worthley; Stephen G Worthley
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-27
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Cardiovascular Research Centre, Royal Adelaide Hospital & Discipline of Medicine, University of Adelaide, Adelaide, Australia.
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