title: Significance of additional ST segment elevation in patients with no reflow after angioplasty for acute myocardial infarction.
abstract: 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.
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.forename: Merita
authors.initials: M
authors.lastname: Shehu
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.forename: Giovanni M
authors.initials: GM
authors.lastname: Santoro
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: 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*