Significance of additional ST segment elevation in patients with no reflow after angioplasty for acute myocardial infarction.
OBJECTIVE
We sought to evaluate the incidence, timing, and clinical significance of additional increase in ST segment elevation (ST-SE) in patients showing no reflow after angioplasty for acute myocardial infarction.


METHODS
We studied 26 patients with acute myocardial infarction showing myocardial contrast echocardiography no reflow after successful angioplasty. Baseline and 6-month 2-dimensional echocardiograms were obtained in 21 surviving patients.


RESULTS
After angioplasty, 13 patients showed greater than 30% additional increase in ST-SE (group 1), whereas 13 did not (group 2). Baseline clinical, echographic, and angiographic characteristics, and 6-month patency and restenosis rate, were similar between the two groups. From baseline to 6 months, a similar global and regional systolic function was found between the two groups, whereas a higher increase in left ventricular end-diastolic volume occurred in group 1 (135 +/- 45 vs 168 +/- 42 mL, P = .033). The additional increase in ST-SE was not associated with more severe microvascular damage (myocardial contrast echocardiography score index: 0.14 +/- 0.26 vs 0.22 +/- 0.27), higher peak creatine kinase value (4888 +/- 2533 vs 3109 +/- 2055 U/L, P = .061), higher incidence of left ventricular remodeling (73% vs 60%, P = .537), or worse outcome (26 +/- 24 months) such as death (15% vs 23%, P = .619), hospitalization for heart failure (8% vs 23%, P = .277), or reinfarction (8% vs 0%, P = .308).


CONCLUSIONS
Our data show that in patients showing no reflow after angioplasty a transient additional increase in ST-SE occurs in half of patients. The prognostic value of additional increase in ST-SE remains uncertain in the era of primary angioplasty.
Carrabba
Nazario
N
Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
Parodi
Guido
G
Valenti
Renato
R
Shehu
Merita
M
Migliorini
Angela
A
Santoro
Giovanni M
GM
Antoniucci
David
D
D015906:Angioplasty, Balloon, Coronary; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology*; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D011379:Prognosis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000517:prevention & control*