PMID- 18984067
OWN - NLM
STAT- MEDLINE
DCOM- 20090227
LR  - 20220310
IS  - 1532-8430 (Electronic)
IS  - 0022-0736 (Linking)
VI  - 42
IP  - 1
DP  - 2009 Jan-Feb
TI  - ST changes before and during primary percutaneous coronary intervention predict 
      final infarct size in patients with ST elevation myocardial infarction.
PG  - 64-72
LID - 10.1016/j.jelectrocard.2008.08.038 [doi]
AB  - BACKGROUND: In patients with ST elevation myocardial infarction (STEMI), 
      spontaneous ST resolution (spontSTR) is a marker of successful microvascular 
      reperfusion. The significance of increase in ST elevation during reperfusion 
      therapy (the ST peak phenomenon), however, is controversial. AIMS: The purpose of 
      the study was to evaluate whether preprocedural and periprocedural ST changes 
      predict final infarct size (IS) in STEMI patients treated with primary 
      percutaneous coronary intervention (primary PCI). METHODS: Twelve-lead 
      electrocardiograms (ECGs) were acquired in the prehospital phase and on admission 
      in 200 STEMI patients transferred for primary PCI. Continuous ST monitoring was 
      performed during and 90 minutes after primary PCI. The exact timing of 
      interventional procedures and the resulting thrombolysis in myocardial infarction 
      (TIMI) flow were registered. A 1-month single-photon emission computerized 
      tomography was performed to evaluate IS. Patients were stratified into groups 
      according to preprocedural and periprocedural ST changes as follows: patients 
      with spontSTR before primary PCI and without (A) or with (B) ST peak during 
      primary PCI and patients with persistent ST elevation before primary PCI and 
      without (C) or with (D) ST peak during primary PCI. FINDINGS: Groups A (n = 45), 
      B (n = 10), C (n = 109), and D (n = 36) differed with regard to IS (median, 2%, 
      3%, 13% vs 22% of the left ventricle; P < .0001). In multivariable analysis 
      adjusting for baseline characteristics, preprocedural and periprocedural ECG 
      findings and routine angiography findings, spontSTR was associated with smaller 
      IS (B = -8.6%; P < .001), whereas the ST peak phenomenon was associated with 
      larger IS (B = +5.0%; P = .006). There was no difference in TIMI flow grades in 
      relation to coronary interventions among patients with and without ST peak during 
      primary PCI. CONCLUSIONS: In STEMI patients, spontSTR before primary PCI and the 
      ST peak phenomenon during primary PCI predict minor vs extensive IS independent 
      of angiographic patency grades. Further studies are needed to clarify whether the 
      ST peak phenomenon is "a marker of injury before reperfusion" or "a marker of 
      reperfusion-induced injury."
FAU - Terkelsen, Christian Juhl
AU  - Terkelsen CJ
AD  - Department of Cardiology B, Aarhus University Hospital, Aarhus, Denmark. 
      christian_juhl_terkelsen@hotmail.com
FAU - Kaltoft, Anne Kjer
AU  - Kaltoft AK
FAU - Norgaard, Bjarne Linde
AU  - Norgaard BL
FAU - Bottcher, Morten
AU  - Bottcher M
FAU - Lassen, Jens Flensted
AU  - Lassen JF
FAU - Clausen, Karrina
AU  - Clausen K
FAU - Nielsen, Soren Steen
AU  - Nielsen SS
FAU - Thuesen, Leif
AU  - Thuesen L
FAU - Nielsen, Torsten Toftegaard
AU  - Nielsen TT
FAU - Botker, Hans Erik
AU  - Botker HE
FAU - Andersen, Henning Rud
AU  - Andersen HR
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20081104
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
MH  - *Angioplasty, Balloon, Coronary
MH  - Electrocardiography/*methods
MH  - Humans
MH  - Myocardial Infarction/*diagnosis/*surgery
MH  - Prognosis
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Treatment Outcome
EDAT- 2008/11/06 09:00
MHDA- 2009/02/28 09:00
CRDT- 2008/11/06 09:00
PHST- 2008/05/18 00:00 [received]
PHST- 2008/11/06 09:00 [entrez]
PHST- 2008/11/06 09:00 [pubmed]
PHST- 2009/02/28 09:00 [medline]
AID - S0022-0736(08)00343-9 [pii]
AID - 10.1016/j.jelectrocard.2008.08.038 [doi]
PST - ppublish
SO  - J Electrocardiol. 2009 Jan-Feb;42(1):64-72. doi: 
      10.1016/j.jelectrocard.2008.08.038. Epub 2008 Nov 4.