title: ST-segment depression resolution predicts infarct size and reperfusion injury in ST-elevation myocardial infarction.
abstract: OBJECTIVE
  ST-elevation myocardial infarction (STEMI) is frequently associated with reciprocal ST-segment depression in contralateral ECG leads. However, the relationship of the resolution of ST-segment depression (STD-R) with myocardial damage is unknown and the potential prognostic value incompletely understood. We sought to evaluate the association between STD-R and markers of myocardial injury as well as to determine the prognostic impact of STD-R in patients with acute reperfused STEMI.
  
  
  METHODS
  We enrolled 611 patients with STEMI in this multicentre cardiac magnetic resonance (CMR) study. STD-R, defined as either worsened (<0%), incomplete (0-50%) or complete (≥50%), was determined 90 min after primary percutaneous coronary intervention (PCI). Patients underwent CMR in median 3 (2-4) days after infarction. Major adverse cardiac events (MACE) were defined as a composite of death, reinfarction and new congestive heart failure within 12 months after enrollment.
  
  
  RESULTS
  Patients with worsened or incomplete STD-R (n=148 (24.2%)) had a significantly larger area at risk (42 (31-50) vs 37 (29-52) vs 34 (24-46) %LV, p=0.001), larger infarct size (20 (13-30) vs 17(10-26) vs 16 (8-24) %LV, p=0.003), larger extent of microvascular obstruction (0.6(0-3.4) vs 0.4 (0-2.4) vs 0.0 (0-1.4) %LV, p=0.003), and a lower LVEF (46 (39-54) vs 48 (40-56) vs 52 (45-58) %, p<0.001). MACE rate (n=37 (6%)) was significantly higher in patients with worsened (n=10 (19%)) or incomplete STD-R (n=7 (7%)) than in patients with complete STD-R (n=20 (4%), p<0.001). In multivariate Cox regression analysis, categorised STD-R emerged as an independent predictor of MACE at 12 months after adjusting for clinical variables (p=0.007).
  
  
  CONCLUSIONS
  Patients with acute STEMI and worsened or incomplete STD-R after PCI show a more pronounced myocardial as well as microvascular damage as detected by CMR with subsequent independent prognostic information on MACE over a 12-month follow-up period.
authors.affiliation: Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Sebastian J
authors.initials: SJ
authors.lastname: Reinstadler
authors.affiliation: Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Anett
authors.initials: A
authors.lastname: Baum
authors.affiliation: Clinic for Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Karl-Philipp
authors.initials: KP
authors.lastname: Rommel
authors.affiliation: Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.affiliation: Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Meinhard
authors.initials: M
authors.lastname: Mende
authors.affiliation: Cardiology and Angiology, University Clinic of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Metzler
authors.affiliation: Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Poess
authors.affiliation: Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
mesh_terms: D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology*; D015425:Myocardial Reperfusion / Q000009:adverse effects; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000473:pathology*; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D011379:Prognosis; D012372:ROC Curve