The evaluation of an electrocardiographic myocardial ischemia acuteness score to predict the amount of myocardial salvage achieved by early percutaneous coronary intervention

• Published in: Journal of electrocardiology Vol. 44; no. 5; pp. 525 - 532
• Main Authors: Engblom, Henrik, MD, PhD, Strauss, David G., MD, PhD, Heden, Bo, MD, PhD, Hedström, Erik, MD, PhD, Jovinge, Stefan, MD, PhD, Götberg, Matthias, MD, PhD, Erlinge, David, MD, PhD, Wagner, Galen S., MD, Arheden, Håkan, MD, PhD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 2011
• Subjects: Acute myocardial infarction; Cardiovascular; Electrocardiography; Magnetic resonance imaging; Myocardial perfusion SPECT; Myocardial salvage; Reperfusion therapy; Electrocardiography; Myocardial perfusion SPECT; Reperfusion therapy; Myocardial salvage; Magnetic resonance imaging; Acute myocardial infarction
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2011.03.008

Abstract Background The time from symptom onset to reperfusion in acute myocardial infarction (MI) has been shown to be a poor predictor of patient outcome. Acute electrocardiographic (ECG) changes, however, have been shown useful for estimated acuteness of myocardial ischemia using the Anderson-Wilkins ECG ischemia acuteness score (AW-acuteness score). The aim was to study whether acute ischemic ECG changes can predict the amount of salvageable myocardium in patients with acute ST-elevation MI. Methods Thirty-eight patients treated with primary percutaneous coronary intervention for first-time ST-elevation MI were retrospectively enrolled. Myocardium at risk (MaR) was determined by myocardial perfusion single photon emission computed tomography acutely or by T2-weighted cardiac magnetic resonance after 1 week, at the same time when final MI size was determined by late gadolinium enhancement. Myocardial salvage was calculated as (MaR − MI size)/MaR and compared with AW-acuteness score and time from symptom onset to primary percutaneous coronary intervention. Results The AW-acuteness score correlated significantly with salvageable myocardium for right coronary artery (RCA) occlusions ( r = −0.57; P = .02) but not for left anterior descending artery (LAD) occlusions ( r = −0.04; P = .88). Time from symptom onset did not correlate with the amount of salvageable myocardium (LAD, r = 0.04 and P = .87; RCA, r = −0.40 and P = .13). Conclusions There is a moderate correlation between AW-acuteness score and salvageable myocardium in patients with acute RCA occlusion but not in patients with LAD occlusion.