Reperfusion arrhythmias during coronary angioplasty for acute myocardial infarction predict ST-segment resolution.
BACKGROUND
Despite early recanalization of an occluded infarct-related artery, myocardial reperfusion may remain impaired due to microvascular injury. Reperfusion arrhythmias may indicate successful microvascular reperfusion.


METHODS
Microvascular reperfusion was assessed prospectively in 42 consecutive patients with ST-segment elevation acute myocardial infarction (AMI) by evaluation of the resolution of ST-segment elevation (<50% of initial level) immediately after successful coronary angioplasty. Patients were divided into two groups: those with ST resolution (n=24) and those without ST resolution (n=18). The presence of reperfusion arrhythmias immediately after recanalization was recorded.


RESULTS
Patients with ST resolution were younger (54+/-12 years compared with 64+/-17 years, P=0.04), their pain-to-recanalization time was shorter (195+/-87 min compared with 294+/-179 min, P=0.05), they were less often diabetic (13% compared with 24%, P=0.05) and were more often given IIb/IIIa inhibitors (58% compared with 22%, P=0.02). Reperfusion arrhythmias were observed in 15 out of 24 patients with ST resolution (62%) but in only one out of 18 without ST resolution (5%) (P<0.01). Reperfusion arrhythmias included accelerated idioventricular rhythm, 13 (81%); multifocal ventricular premature beats, two (13%); and ventricular tachycardia, one (6%). The sensitivity and specificity of reperfusion arrhythmias for ST resolution were 62 and 95%, respectively. In a logistic regression model including age, time to treatment, diabetes, use of IIb/IIIa inhibitors and reperfusion arrhythmias, only the latter was found to be an independent predictor of ST resolution (P<0.01).


CONCLUSIONS
Reperfusion arrhythmias following coronary angioplasty for AMI are a highly specific marker for ST resolution and may indicate successful microvascular reperfusion.
Ilia
Reuben
R
Department of Cardiology, Soroka Medical Center, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva 84101, Israel. iliar@bgumail.bgu.il
Amit
Guy
G
Cafri
Carlos
C
Gilutz
Harel
H
Abu-Ful
Akram
A
Weinstein
Jean Marc
JM
Yaroslavtsev
Sergey
S
Gueron
Moche
M
Zahger
Doron
D
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex