title: Relation between ST-segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty.
abstract: The aim of this study was to evaluate the relation between myocardial perfusion and ST-segment changes in patients with acute myocardial infarction treated with successful direct angioplasty. Thirty-seven patients, successfully treated with direct angioplasty, underwent myocardial contrast echocardiography before and after angioplasty. The sum of ST-segment elevation divided by the number of the leads involved (ST-segment elevation index) was calculated at 1, 5, 10, 20, and 30 minutes after restoration of a Thrombolysis In Myocardial Infarction trial grade 3 flow. After recanalization, myocardial reperfusion within the risk area was observed in 26 patients, whereas a no-reflow phenomenon occurred in 11. In patients with myocardial reperfusion, the ST-segment elevation index progressively declined, whereas in patients with no reflow, no significant change was observed. Reduction of > or = 50% in the ST-segment elevation index occurred in 20 of the 26 patients with reflow and in 1 of the 11 with no reflow (p = 0.0002). An additional increase of > or = 30% in the ST-segment elevation index occurred in 3 patients with reflow and in 7 with no reflow (p = 0.003). Sensitivity, specificity, positive and negative predictive values, and accuracy of the reduction in the ST-segment elevation index for predicting microvascular reflow were 77%, 91%, 95%, 62%, and 81%, respectively. The corresponding values of the increase in ST-segment elevation index for predicting no reflow were 64%, 88%, 70%, 85%, and 81%, respectively. In conclusion, after successful angioplasty, different patterns of myocardial perfusion are associated with different ST-segment changes. Analysis of ST-segment changes predicts the degree of myocardial reperfusion.
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Santoro
authors.forename: R
authors.initials: R
authors.lastname: Valenti
authors.forename: P
authors.initials: P
authors.lastname: Buonamici
authors.forename: L
authors.initials: L
authors.lastname: Bolognese
authors.forename: G
authors.initials: G
authors.lastname: Cerisano
authors.forename: G
authors.initials: G
authors.lastname: Moschi
authors.forename: M
authors.initials: M
authors.lastname: Trapani
authors.forename: D
authors.initials: D
authors.lastname: Antoniucci
authors.forename: P F
authors.initials: PF
authors.lastname: Fazzini
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D015425:Myocardial Reperfusion; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity