Functional and structural correlates of persistent ST elevation after acute myocardial infarction successfully treated by percutaneous coronary intervention.
BACKGROUND
In the thrombolytic era, persistence of ST-segment elevation was considered a marker of left ventricular (LV) aneurysm. ST-segment elevation may still be found persistently raised after successful primary percutaneous coronary intervention (PCI). Echocardiographic correlates of this finding, however, are still poorly known.


RESULTS
82 consecutive patients with first ST-segment elevation myocardial infarction and successful PCI were divided into patients with persistent ST-segment elevation at discharge (sum of ST >4 mm) (n = 33) and those without persistent ST-segment elevation (n = 49). Conventional and myocardial contrast echocardiography were performed at discharge and at 6 months. At discharge, LV aneurysm was more common in patients with persistent ST elevation (27% vs 8%, p<0.005). Similarly, the wall motion score index was higher (2.5 vs 2.0, p<0.005) and microvascular damage larger (2.3 vs 1.8, p<0.005) in patients with persistent ST-segment elevation. At 6 months' follow-up, LV volumes were similar in the two groups.


CONCLUSIONS
After primary PCI, persistent ST-segment elevation is associated with LV aneurysm formation in 30% of cases, it is not associated with significantly larger LV dilatation but with larger microvascular damage and dysfunctioning risk area.
Galiuto
Leonarda
L
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. lgaliuto@rm.unicatt.it
Barchetta
Sabrina
S
Paladini
Serena
S
Lanza
Gaetano
G
Rebuzzi
Antonio G
AG
Marzilli
Mario
M
Crea
Filippo
F
D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006322:Heart Aneurysm / Q000175:diagnosis / Q000000981:diagnostic imaging; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D011446:Prospective Studies; D014463:Ultrasonography; D020257:Ventricular Remodeling