ST-segment re-elevation unrelated to left ventricular ejection fraction or volume after anterior wall acute myocardial infarction treated with successful reperfusion

Matano, Sakae; Iwasaki, Kohichiro; Kusachi, Shozo; Murakami, Takashi; Kurazono, Sekiko; Yamaji, Hirosuke; Hamamoto, Hiromi; Takamura, Toshiyuki; Hina, Kazuyoshi; Tsuji, Takao

doi:10.1054/jelc.2002.31818

Cited by 5 publications

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“…The incidence of ST segment re-elevation in STEMI patients in the present study was similar to that reported in previous studies, which ranged between 23% and 29%. 10,12, 14 The absence of a significant relationship with any clinical endpoint is consistent with the findings of Matano et al 14 In that study on patients with anterior STEMI, the authors did not find any difference in LVEF or LVEDV between patients with or without ST-segment re-elevation, and the study did not have sufficient power to assess clinical outcomes. The present study in a larger (and more homogeneous) population of patients with anterior STEMI is more powerful, and takes the findings of Matano et al 14 further by showing the absence of any correlation between ST segment re-elevation and clinical outcomes.…”

Section: Discussionsupporting

confidence: 67%

“…There are few data regarding the significance of ST segment reelevation after reperfusion, with most data coming from small clinical studies that were performed before the PPCI reperfusion era. [10][11][12][13][14] In these small studies, the results are discordant, suggesting either increased severity in myocardial injury, 10 increased infarct size and poorer LV functional outcomes, 11,12 subclinical pericarditis, 13 or no significant effect on LV functional outcomes. 14 Moreover, there have been no studies examining the relationship between ST segment re-elevation and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The proportion of patients with ST segment re-elevation in the present was 19%, which is comparable with other published data. 10, 14 …”

Section: Study Limitationsmentioning

confidence: 99%

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Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction　― Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year―

Cuenin

Lamoureux

Schaaf

et al. 2018

Circ J

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been associated with the extent of myocardial damage, re-infarction, left ventricular (LV) remodeling, and mortality. 1- 5 Regression of ST segment elevation has been used in several studies to assess the quality of reperfusion. 6-9 T he electrocardiogram (ECG) is the first-line diagnostic tool in ST elevation myocardial infarction (STEMI). The ECG is a simple and easily reproducible test, with a non-ambiguous diagnostic ability.ST segment resolution is commonly used as a marker of successful reperfusion. It is an independent prognostic parameter of subsequent adverse events in STEMI patients. In many studies, the absence of ST segment resolution has Background: Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction　― Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year―

Cuenin

Lamoureux

Schaaf

et al. 2018

Circ J

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“…It was found that ST-segment re-elevation (reSTE) following primary PCI observed in one fifth of patients with anterior STEMI with an occluded IRA on initial contrast injection was not associated with increased infarct size, left ventricular (LV) function or clinical outcomes at 1 year [9,10]. In contrast, lack of ST-segment resolution or reSTE within 24 h following PCI was associated with increased enzymatic injury and reduced LV function [11].…”

Section: Introductionmentioning

confidence: 99%

ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

Krawczyk

Stępień

Nowak

et al. 2019

pwki

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Introduction: Spontaneous recanalization of the infarct-related artery (IRA) in ST-segment elevation myocardial infarction (STEMI) before primary angioplasty (PCI) improves clinical outcomes. Aim: To investigate the impact of ST-segment re-elevation (reSTE) following PCI in patent IRA on left ventricular (LV) function recovery and remodeling. Material and methods: Of 155 STEMI patients with patent IRA, 19 (12.3%) patients with TIMI-2 (T2 Res) and 85 (54.8%) with TIMI-3 (T3 Res) had further STE resolution following PCI, 20 (12.9%) with TIMI-3 did not require PCI (T3 noPCI) and 31 (20.0%) with TIMI-2/3 had reSTE of ≥ 1 mm following PCI as compared with pre-PCI recordings (T23 reSTE). LV ejection fraction (LVEF, %) and LV end-diastolic and end-systolic volume indexes (LVEDVI, LVESVI, ml/m 2) were measured by echocardiography 2 days and 6 months following PCI. Results: In 6-month observation the improvement of LVEF in T3 Res (by 3.9 ±5.1%) and in T3 noPCI (by 5.7 ±6.1%) patients was higher as compared with T23 reSTE (0.2 ±7.0%, p < 0.05 versus both). LVEDVI increased in T23 reSTE patients by 6.6 ±12.6 ml/m 2 , but decreased in T3 Res by 3.8 ±9.7 ml/m 2 and in T3 noPCI by 2.4 ±6.2 ml/m 2 (for both p < 0.05 vs. T23 reSTE). LVESVI increased in T23 reSTE patients (by 3.8 ±10.8 ml/m 2), did not change in T2 Res (by 0.1 ±9.0 ml/m 2), but decreased in T3 Res (by 4.2 ±7.2 ml/m 2 , p < 0.05 vs. T23 reSTE) and in T3 noPCI patients (by 4.7 ±7.7 ml/m 2 , p < 0.05 vs. T23 reSTE). ReSTE was an independent predictor of LVEF, LVEDVI and LVESVI changes (p < 0.001 for all). Conclusions: ReSTE following PCI in a patent IRA is associated with a lack of improvement of LV contractility and subsequent LV remodeling.

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“…Matano et al reported that ST re-elevation occurred in 29% of the patients, but that there was no difference in ejection fraction (EF) at 1 month between the patients with and without ST re-elevation. 4…”

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confidence: 99%

Is There Any Impact of ST Re-elevation on Patients With Acute Myocardial Infarction Following Reperfusion Therapy?

Tanabe

2018

Circ J

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re-elevation, despite initial ST resolution, occurred in 23% of the patients, and was associated with poorer EF at 6 months. They divided their patients into 3 groups (ST resolution without re-elevation, ST resolution with reelevation, and no ST resolution), and showed the serial ECG changes (Figure). In this issue of the Journal, Cuenin et al 8 report that 19% of 662 patients experienced ST segment re-elevation, but there were no differences in EF or death at 1 year between patients with and without re-elevation. Although the incidence of ST re-elevation was similar to that reported by Okuda et al, the effect on EF was inconsistent. Several differences between the 2 studies may have influenced the results. First, the timing of evaluation for ST re-elevation was different. Most previous studies evaluated ST resolution within several hours after reperfusion therapy, and ST resolution was consistently associated with better clinical outcomes. The mechanism of ST re-elevation is unclear and its occurrence suggests the possibility of re-infarction or pericarditis. In fact, stent P rimary percutaneous coronary intervention (PCI) to recanalize an occluded artery has been the main treatment for acute myocardial infarction (AMI), but a substantial number of patients still develop large infarcts. Impaired microvascular reperfusion, which is evaluated by the absence of resolution of ST-segment elevation (ST resolution) on the 12-lead ECG following reperfusion therapy, is considered to be associated with worse final TIMI (Thrombolysis in Myocardial Infarction) flow grade and large infarcts. 1 Furthermore, the measure of ST resolution has been reported to correlate with left ventricular function, survival, and reinfarction during longterm follow-up after both primary PCI and thrombolytic therapy. 1-7 ST resolution occurs in 64-85% of patients, as shown in the Table. Only a few previous reports have investigated the prevalence of ST segment re-elevation even though ECG is a standard and simple diagnostic modality. Matano et al reported that ST re-elevation occurred in 29% of the patients, but that there was no difference in ejection fraction (EF) at 1 month between the patients with and without ST re-elevation. 4 In contrast, Okuda et al 6 reported that ST

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ST-segment re-elevation unrelated to left ventricular ejection fraction or volume after anterior wall acute myocardial infarction treated with successful reperfusion

Cited by 5 publications

References 0 publications

Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction　― Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year―

Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction　― Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year―

ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

Is There Any Impact of ST Re-elevation on Patients With Acute Myocardial Infarction Following Reperfusion Therapy?

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ST-segment re-elevation unrelated to left ventricular ejection fraction or volume after anterior wall acute myocardial infarction treated with successful reperfusion

Cited by 5 publications

References 0 publications

Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction ― Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year―

Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction ― Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year―

ST-segment re-elevation following primary angioplasty in acute myocardial infarction with patent infarct-related artery: impact on left ventricular function recovery and remodeling

Is There Any Impact of ST Re-elevation on Patients With Acute Myocardial Infarction Following Reperfusion Therapy?

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Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction　― Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year―

Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction　― Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year―