title: Prognostic significance and relationship of worst lead residual ST segment elevation with myocardial damage assessed by cardiovascular MRI in myocardial infarction.
abstract: OBJECTIVE
  To investigate the relation of residual worst lead ST segment elevation (WL-STE) after ST segment myocardial infarction (STEMI) with infarct size and microvascular injury assessed by cardiovascular magnetic resonance (CMR) imaging.
  
  
  BACKGROUND
  WL-STE in patients with acute reperfused STEMI has been shown to identify high risk patients for major adverse cardiovascular events (MACE). However, the relation of WL-STE with myocardial damage is unknown.
  
  
  METHODS
  In this multicentre study we analysed ECG data 90 min after primary percutaneous coronary intervention (PCI) in 763 STEMI patients. WL-STE was defined as the absolute magnitude of STE in the most affected lead on the post-PCI ECG. Patients were categorised into three groups (<1 mm, 1-2 mm, and ≥2 mm). CMR was performed within 1 week after infarction for comprehensive assessment of myocardial damage using a standardised protocol. The primary clinical endpoint was MACE defined as death, reinfarction, and new congestive heart failure within 12 months after infarction.
  
  
  RESULTS
  WL-STE <1 mm, 1-2 mm, and ≥2 mm was present in 155 (20%), 328 (43%), and 280 (37%) patients, respectively. Myocardial damage determined by CMR demonstrated a graded relationship of infarct size (median (IQR) 13.3 (6.2-20.3)%LV vs 13.7 (7.6-21.3)%LV vs 22.5 (15.6-31.2)%LV, p<0.001), the myocardial salvage index (60.8 (37.0-84.5) vs 55.0 (36.6-73.9) vs 42.7 (26.2-58.2), p<0.001), and microvascular obstruction (0.0 (0.0-0.9)%LV vs 0.0 (0-1.0)%LV vs 1.2 (0.0-3.6)%LV, p<0.001) across the three groups. WL-STE ≥2 mm was strongly associated with MACE 12 month after infarction (HR 1.93, 95% CI 1.11 to 3.37; p=0.02).
  
  
  CONCLUSIONS
  This largest CMR study to date correlating post-PCI WL-STE with markers of myocardial damage demonstrates that WL-STE is significantly associated with infarct size, myocardial salvage, microvascular obstruction, and MACE in a high risk STEMI population.
  
  
  BACKGROUND
  NCT00712101.
authors: Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany.
authors: K P
authors: KP
authors: Rommel
authors: Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany.
authors: A
authors: A
authors: Baum
authors: University of Leipzig, Centre for Clinical Trials, Leipzig, Germany.
authors: M
authors: M
authors: Mende
authors: Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany Department of Cardiology, Angiology, Intensive Care Medicine, University of Lübeck, Medical Clinic II, Lübeck, Germany.
authors: S
authors: S
authors: Desch
authors: Department of Diagnostic/Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany.
authors: M
authors: M
authors: Gutberlet
authors: Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany.
authors: G
authors: G
authors: Schuler
authors: Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany Department of Cardiology, Angiology, Intensive Care Medicine, University of Lübeck, Medical Clinic II, Lübeck, Germany.
authors: H
authors: H
authors: Thiele
authors: Department of Internal Medicine/Cardiology, University of Leipzig, Heart Center, Leipzig, Germany Department of Cardiology, Angiology, Intensive Care Medicine, University of Lübeck, Medical Clinic II, Lübeck, Germany.
authors: I
authors: I
authors: Eitel
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D055806:Microvessels / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: cardiac magnetic resonance; electrocardiogram; infarction; prognosis