Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty

• Published in: The American journal of cardiology Vol. 82; no. 8; pp. 932 - 937
• Main Authors: Santoro, Giovanni M, Valenti, Renato, Buonamici, Piergiovanni, Bolognese, Leonardo, Cerisano, Giampaolo, Moschi, Guia, Trapani, Maurizio, Antoniucci, David, Fazzini, Pier Filippo
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.10.1998; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Coronary Circulation; Coronary heart disease; Echocardiography - methods; Electrocardiography; Female; Heart; Heart attacks; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Reperfusion; Prognosis; Prospective Studies; Sensitivity and Specificity; Sonography; Human; Echocardiography; Infarct; Acute; Treatment efficiency; Coronary artery; Instrumentation therapy; ST interval; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Myocardial disease; Electrodiagnosis; Treatment; Electrocardiography; Myocardium; Contrast media
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00508-6

The aim of this study was to evaluate the relation between myocardial perfusion and ST-segment changes in patients with acute myocardial infarction treated with successful direct angioplasty. Thirty-seven patients, successfully treated with direct angioplasty, underwent myocardial contrast echocardiography before and after angioplasty. The sum of ST-segment elevation divided by the number of the leads involved (ST-segment elevation index) was calculated at 1, 5, 10, 20, and 30 minutes after restoration of a Thrombolysis In Myocardial Infarction trial grade 3 flow. After recanalization, myocardial reperfusion within the risk area was observed in 26 patients, whereas a no-reflow phenomenon occurred in 11. In patients with myocardial reperfusion, the ST-segment elevation index progressively declined, whereas in patients with no reflow, no significant change was observed. Reduction of ≥50% in the ST-segment elevation index occurred in 20 of the 26 patients with reflow and in 1 of the 11 with no reflow (p = 0.0002). An additional increase of ≥30% in the ST-segment elevation index occurred in 3 patients with reflow and in 7 with no reflow (p = 0.003). Sensitivity, specificity, positive and negative predictive values, and accuracy of the reduction in the ST-segment elevation index for predicting microvascular reflow were 77%, 91%, 95%, 62%, and 81%, respectively. The corresponding values of the increase in ST-segment elevation index for predicting no reflow were 64%, 88%, 70%, 85%, and 81%, respectively. In conclusion, after successful angioplasty, different patterns of myocardial perfusion are associated with different ST-segment changes. Analysis of ST-segment changes predicts the degree of myocardial reperfusion.