Document Detail


Reperfusion arrhythmias during coronary angioplasty for acute myocardial infarction predict ST-segment resolution.
MedLine Citation:
PMID:  12966264     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite early recanalization of an occluded infarct-related artery, myocardial reperfusion may remain impaired due to microvascular injury. Reperfusion arrhythmias may indicate successful microvascular reperfusion. METHODS: Microvascular reperfusion was assessed prospectively in 42 consecutive patients with ST-segment elevation acute myocardial infarction (AMI) by evaluation of the resolution of ST-segment elevation (<50% of initial level) immediately after successful coronary angioplasty. Patients were divided into two groups: those with ST resolution (n=24) and those without ST resolution (n=18). The presence of reperfusion arrhythmias immediately after recanalization was recorded. RESULTS: Patients with ST resolution were younger (54+/-12 years compared with 64+/-17 years, P=0.04), their pain-to-recanalization time was shorter (195+/-87 min compared with 294+/-179 min, P=0.05), they were less often diabetic (13% compared with 24%, P=0.05) and were more often given IIb/IIIa inhibitors (58% compared with 22%, P=0.02). Reperfusion arrhythmias were observed in 15 out of 24 patients with ST resolution (62%) but in only one out of 18 without ST resolution (5%) (P<0.01). Reperfusion arrhythmias included accelerated idioventricular rhythm, 13 (81%); multifocal ventricular premature beats, two (13%); and ventricular tachycardia, one (6%). The sensitivity and specificity of reperfusion arrhythmias for ST resolution were 62 and 95%, respectively. In a logistic regression model including age, time to treatment, diabetes, use of IIb/IIIa inhibitors and reperfusion arrhythmias, only the latter was found to be an independent predictor of ST resolution (P<0.01). CONCLUSION: Reperfusion arrhythmias following coronary angioplasty for AMI are a highly specific marker for ST resolution and may indicate successful microvascular reperfusion.
Authors:
Reuben Ilia; Guy Amit; Carlos Cafri; Harel Gilutz; Akram Abu-Ful; Jean Marc Weinstein; Sergey Yaroslavtsev; Moche Gueron; Doron Zahger
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Coronary artery disease     Volume:  14     ISSN:  0954-6928     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-09-10     Completed Date:  2004-03-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  439-41     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Soroka Medical Center, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva 84101, Israel. iliar@bgumail.bgu.il
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Arrhythmias, Cardiac / diagnosis*,  mortality,  therapy*
Electrocardiography*
Female
Hospital Mortality
Humans
Intraoperative Complications / etiology*,  mortality,  therapy*
Israel
Male
Middle Aged
Myocardial Infarction / diagnosis*,  mortality,  therapy*
Myocardial Reperfusion Injury / diagnosis*,  mortality,  therapy*
Platelet Glycoprotein GPIIb-IIIa Complex / therapeutic use
Postoperative Complications / drug therapy,  etiology,  mortality
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Glycoprotein GPIIb-IIIa Complex

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