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Rev Esp Cardiol (Engl Ed). 2019 Feb;72(2):120-129. doi: 10.1016/j.rec.2018.01.005. Epub 2018 Feb 23.

Clinical Significance of Reciprocal ST-segment Changes in Patients With STEMI: A Cardiac Magnetic Resonance Imaging Study.

[Article in English, Spanish]

Author information

1
Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea.
2
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
3
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: youngbin.song@gmail.com.
4
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
5
Division of Cardiology, Department of Medicine, Namyangju Baek Hospital, Namtangju, Republic of Korea.
6
Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
7
Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea.
8
Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada.

Abstract

INTRODUCTION AND OBJECTIVES:

We sought to determine the association of reciprocal change in the ST-segment with myocardial injury assessed by cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

METHODS:

We performed CMR imaging in 244 patients who underwent primary PCI for their first STEMI; CMR was performed a median 3 days after primary PCI. The first electrocardiogram was analyzed, and patients were stratified according to the presence of reciprocal change. The primary outcome was infarct size measured by CMR. Secondary outcomes were area at risk and myocardial salvage index.

RESULTS:

Patients with reciprocal change (n=133, 54.5%) had a lower incidence of anterior infarction (27.8% vs 71.2%, P < .001) and shorter symptom onset to balloon time (221.5±169.8 vs 289.7±337.3min, P=.042). Using a multiple linear regression model, we found that patients with reciprocal change had a larger area at risk (P=.002) and a greater myocardial salvage index (P=.04) than patients without reciprocal change. Consequently, myocardial infarct size was not significantly different between the 2 groups (P=.14). The rate of major adverse cardiovascular events, including all-cause death, myocardial infarction, and repeat coronary revascularization, was similar between the 2 groups after 2 years of follow-up (P=.92).

CONCLUSIONS:

Reciprocal ST-segment change was associated with larger extent of ischemic myocardium at risk and more myocardial salvage but not with final infarct size or adverse clinical outcomes in STEMI patients undergoing primary PCI.

KEYWORDS:

Area at risk; Cambios recíprocos del electrocardiograma; Cardiac magnetic resonance imaging; Infarto de miocardio con elevación del segmento ST; Reciprocal change of electrocardiogram; Resonancia magnética cardiaca; ST-segment elevation myocardial infarction; Área en riesgo

PMID:
29478870
DOI:
10.1016/j.rec.2018.01.005

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