Intracoronary ECG ST-segment recovery during primary percutaneous intervention for ST-segment myocardial infarction: Insights from a cardiac MRI study

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

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    Background ST-segment-resolution (STR) on surface electrocardiogram (ECG) is a good surrogate for myocardial reperfusion in patients with acute ST-segment-elevation-myocardial-infarction (STEMI). We sort to determine the optimal criteria of measuring STR on intracoronary-ECG (IC-ECG) for prediction of myocardial injury evaluated by cardiac MRI (CMR). Methods Measurements of IC-ECG ST-segments were performed at baseline, immediately after (early) and 15 min (late) after achieving TIMI-3 flow during primary-PCI. The degree of ST-segment-shift from baseline noted upon the IC-ECG was divided into four groups: (group 1) ST-segment-resolution >1 mm, (group 2) <30% resolution, (group 3) >50% resolution, (group 4) >70% resolution at both early and late time points. Patients had CMR at days 3 and 90 postprimary-PCI. Results Fifty two patients (aged 60 ± 11 years; 43 males) were evaluated. Early intracoronary-ECG ST-segment resolution (early IC-STR >1 mm) correlated with smaller scar mass (P = 0.003), nonviable myocardial mass (P < 0.001), and microvascular obstruction (MVO) (P = 0.004) on CMR at day 3. Ejection fraction (EF) was also better at day 3 (P = 0.026) and 90 (P = 0.039). Patients with poor early IC-STR (IC-STR <30%) conversely is associated with larger scar mass (P = 0.017), nonviable myocardial mass (P = 0.01), and MVO (P = 0.021) at day 3. This was also associated with worse EF at day 90 (P = 0.044). Neither group 3 or 4, or the late measurements of late IC-STR correlated with CMR markers of myocardial injury. Conclusion The degree of early IC-STR (defined by IC-STR > 1 mm or <30%) successfully predicts myocardial damage following primary-PCI for an acute STEMI. Further studies are required to investigate its potential utility. © 2011 Wiley Periodicals, Inc.

    Original languageEnglish
    Pages (from-to)746-753
    Number of pages8
    JournalCatheterization and Cardiovascular Interventions
    Issue number5
    Publication statusPublished - 1 Nov 2012


    • left ventricular remodeling
    • magnetic resonance imaging
    • myocardial injury
    • ST-segment resolution
    • STEMI

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