Intracoronary ECG during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction predicts microvascular obstruction and infarct size

Dennis Wong, Michael Leung, Rajiv Das, Gary Liew, Karen Teo, Derek Chew, I Meredith, Matthew Worthley, Stephen Worthley

    Research output: Contribution to journalArticle

    7 Citations (Scopus)

    Abstract

    Introduction: Microvascular obstruction (MVO) following ST-segment elevation myocardial infarction (STEMI) is associated with larger infarct size and an increased mortality. Although angiographic predictors of MVO in primary percutaneous coronary intervention (primary-PCI) setting have been identified, an earlier and objective "in-lab" predictor may be beneficial, in order to potentially influence therapies administered during primary-PCI. We hypothesised that intracoronary-electrocardiogram (IC-ECG) is a simple, objective and accurate predictor of MVO evaluated by cardiac magnetic resonance (CMR) and is comparable to myocardial blush grade (MBG) and TIMI myocardial perfusion grade (TMPG). Method: Intracoronary ECG was performed during primary-PCI. Intracoronary ST-segment measurement was performed before and immediately after opening of infarct-related-artery. Intracoronary ST-segment resolution (IC-STR) was defined as ≥ 1 mm improvement compared to baseline. Contrast enhanced CMR was performed at 4 and 90 days post primary-PCI. Primary endpoint was MVO on late gadolinium hyperenhancement assessed by CMR at day 4. Results: Sixty-four consecutive patients (age 59 ± 11 years; 55 males) were recruited. Intracoronary ST-segment resolution correlated with MVO (p = 0.005). Furthermore, IC-STR correlated with infarct-mass, non-viable-mass, peak creatinine kinase and end-systolic-volume at day 4. Intracoronary ST-segment resolution also correlated with favourable left ventricular end-diastolic-volume at day 90 (p = 0.022). On multivariate analysis, IC-STR was an independent predictor of MVO. Conclusion: Intracoronary ST-segment resolution is a strong in-lab predictor of MVO assessed 4 days after STEMI on CMR. Furthermore, IC-STR correlates with infarct size and left ventricular remodelling at 3 months. Further studies are required to understand potential clinical utility of this tool.

    Original languageEnglish
    Pages (from-to)61-66
    Number of pages6
    JournalInternational Journal of Cardiology
    Volume165
    Issue number1
    DOIs
    Publication statusPublished - 2013

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