Prognostic significance and relationship of worst lead residual ST segment elevation with myocardial damage assessed by cardiovascular MRI in myocardial infarction

• Published in: Heart (British Cardiac Society) Vol. 100; no. 16; pp. 1257 - 1263
• Main Authors: Rommel, K P, Baum, A, Mende, M, Desch, S, Gutberlet, M, Schuler, G, Thiele, H, Eitel, I
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.08.2014
• Subjects: Acquisitions & mergers; Aged; Biomarkers - blood; Clinical outcomes; Colleges & universities; Coronary Angiography - methods; Coronary Vessels - physiopathology; Electrocardiography; Electrocardiography - methods; Female; Heart attacks; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - etiology; Heart Failure - physiopathology; Humans; Laboratories; Magnetic Resonance Imaging, Cine - methods; Male; Medical prognosis; Methods; Microvessels - physiopathology; Middle Aged; Mortality; Myocardial Infarction - blood; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardium - metabolism; Myocardium - pathology; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Percutaneous Coronary Intervention - statistics & numerical data; Predictive Value of Tests; Prognosis; Regression analysis; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; infarction; electrocardiogram; cardiac magnetic resonance; prognosis
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2013-305462

Objective To investigate the relation of residual worst lead ST segment elevation (WL-STE) after ST segment myocardial infarction (STEMI) with infarct size and microvascular injury assessed by cardiovascular magnetic resonance (CMR) imaging. Background WL-STE in patients with acute reperfused STEMI has been shown to identify high risk patients for major adverse cardiovascular events (MACE). However, the relation of WL-STE with myocardial damage is unknown. Methods In this multicentre study we analysed ECG data 90 min after primary percutaneous coronary intervention (PCI) in 763 STEMI patients. WL-STE was defined as the absolute magnitude of STE in the most affected lead on the post-PCI ECG. Patients were categorised into three groups (<1 mm, 1–2 mm, and ≥2 mm). CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardised protocol. The primary clinical endpoint was MACE defined as death, reinfarction, and new congestive heart failure within 12 months after infarction. Results WL-STE <1 mm, 1–2 mm, and ≥2 mm was present in 155 (20%), 328 (43%), and 280 (37%) patients, respectively. Myocardial damage determined by CMR demonstrated a graded relationship of infarct size (median (IQR) 13.3 (6.2–20.3)%LV vs 13.7 (7.6–21.3)%LV vs 22.5 (15.6–31.2)%LV, p<0.001), the myocardial salvage index (60.8 (37.0–84.5) vs 55.0 (36.6–73.9) vs 42.7 (26.2–58.2), p<0.001), and microvascular obstruction (0.0 (0.0–0.9)%LV vs 0.0 (0–1.0)%LV vs 1.2 (0.0–3.6)%LV, p<0.001) across the three groups. WL-STE ≥2 mm was strongly associated with MACE 12 month after infarction (HR 1.93, 95% CI 1.11 to 3.37; p=0.02). Conclusions This largest CMR study to date correlating post-PCI WL-STE with markers of myocardial damage demonstrates that WL-STE is significantly associated with infarct size, myocardial salvage, microvascular obstruction, and MACE in a high risk STEMI population. Trial registration number NCT00712101.