Does persistent ST-segment elevation after successful PTCA predict worse clinical outcomes in patients with acute myocardial infarction?
Persistent ST-segment elevation after successful primary angioplasty for AMI is a strong independent predictor of major adverse cardiac events at 1 year, highlighting the clinical impact of microvascular reperfusion injury.
BACKGROUND: Despite early recanalization of an occluded infarct artery, reperfusion at the level of the microcirculation may remain impaired owing to a process of microvascular reperfusion injury. METHODS AND RESULTS: Microvascular reperfusion injury was studied in 91 patients with acute myocardial infarction (AMI) by evaluation of the resolution of ST-segment elevation after successful PTCA. Impaired microvascular reperfusion, defined as the presence of persistent (>/=50% of initial value) ST-segment elevation (ST >/=50%) at the end of coronary intervention, was observed in 33 patients (36%) and was independently correlated with low systolic pressure on admission and high age. Patients >/=55 years of age with systolic pressures /=50% versus ST /=50% was the most important independent determinant of MACE with an adjusted risk ratio of 3.4. CONCLUSIONS: Impaired microvascular reperfusion, as evidenced by ST >/=50% after successful recanalization, occurs in more than one third of our AMI patients, especially in older patients with low systolic pressure. Its detrimental implications on clinical outcome reinforce the need to develop adjunctive agents that attenuate the process of reperfusion injury.
Claeys et al. (Tue,) studied this question.