Prognostic value of slow resolution of ST-segment elevation following successful direct percutaneous transluminal coronary angioplasty for recovery of left ventricular function.
Our objective was to investigate the significance of the slow resolution of ST-segment elevation following a successful direct percutaneous transluminal coronary angioplasty (PTCA). ST-segment elevations were calculated from electrocardiograms recorded before PTCA and 1 hour after reperfusion. Forty-nine patients experiencing their first anterior acute myocardial infarction and who had undergone direct PTCA were classified into 3 groups: 17 patients with rapid ST resolution (group I), 23 patients with persistent ST elevation (group II), and 9 patients with ST reelevation (group III). Left ventricular function was evaluated by using single-plane cineventriculography performed in the acute stage, at discharge, and 4 months later. Peak creatine kinase activity was significantly increased: group III (4,046 +/- 634 IU), group II (3,336 +/- 772 IU), and group I (2,410 +/- 994 IU); p <0.05. Ejection fraction and regional wall motion in the acute stage were identical in each group. However, they were significantly higher in group I (67 +/- 6%, -1.01 +/- 0.30), followed by group II (56 +/- 6%, -1.90 +/- 0.41) and group III (38 +/- 7%, -2.79 +/- 0.46); p <0.01 4 months later. Multiple regression analysis revealed that the ST resolution was the only significant variable that indicated the recovery of regional wall motion. A good linear correlation was documented between the ST resolution and the recovery of regional wall motion. We concluded that a slow ST resolution after successful direct PTCA is a negative predictor of recovery of left ventricular function, especially when ST reelevation is evident.
Somitsu
Y
Y
The Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine, Tokyo, Japan.
Nakamura
M
M
Degawa
T
T
Yamaguchi
T
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left