Relationship between ST-segment resolution and anterior infarct size after primary percutaneous coronary intervention: analysis from the INFUSE-AMI trial
| Autor: | C. Michael Gibson, Helen Parise, Sorin J. Brener, Jose Dizon, Jacek Godlewski, Gregg W. Stone, Angelo B. Biviano, Akiko Maehara, Roxana Mehran, Bernard Witzenbichler, Jan-Henk E. Dambrink |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Abciximab Heart Ventricles Infarction Magnetic Resonance Imaging Cine Platelet Glycoprotein GPIIb-IIIa Complex Critical Care and Intensive Care Medicine Coronary Angiography Electrocardiography Immunoglobulin Fab Fragments Reperfusion therapy Percutaneous Coronary Intervention Prognostic Determinants Cardiac magnetic resonance imaging Internal medicine medicine ST segment Humans cardiovascular diseases Myocardial infarction Infusions Intravenous Anterior Wall Myocardial Infarction medicine.diagnostic_test business.industry Percutaneous coronary intervention Antibodies Monoclonal General Medicine Middle Aged medicine.disease Treatment Outcome Cardiology Platelet aggregation inhibitor Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors |
| Popis: | ST-segment resolution (STR) after reperfusion therapy has been shown to correlate with prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether acute ECG measurements also correlate with ultimate infarct size.The INFUSE-AMI trial randomized 452 patients with anterior STEMI to intracoronary bolus abciximab vs. no abciximab, and to thrombus aspiration vs. no aspiration. Infarct size as percentage of total LV mass was calculated by cardiac magnetic resonance imaging (MRI) 30 days post intervention. Five ECG methods were analysed for their ability to predict MRI infarct mass: (1) summed STR across all infarct-related ECG leads (ΣSTR); (2) STR in the single lead with maximum baseline ST-segment elevation (maxSTR); (3) summed residual ST-segment elevation across all infarct-related leads at 60 min post intervention (ΣST residual); (4) maximum residual ST-segment elevation in the worst single lead at 60 min post intervention (maxST residual); (5) number of new significant Q-waves (Qwave) at 60 min. All ECG methods strongly correlated with 30-day MRI infarct mass (all p0.003). Simpler ECG measurements such as maxSTresidual and Qwave were as predictive as more complex measurements. A subset analysis of 158 patients who had microvascular obstruction (MVO) determined by MRI 5 days post intervention also showed strong correlations of MVO with the ECG measures.ST-segment and Q-wave changes after primary PCI in anterior STEMI strongly correlated with 30-day infarct size by MRI. In particular, maxST residual and Qwave at 60 min are simple ECG parameters that offer rapid analysis for prognostication. |
| Databáze: | OpenAIRE |
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