Association between anterior ST depression and increased myocardial salvage following reperfusion therapy in patients with inferior myocardial infarction

Mark A. Evans, Ian P. Clements, Timothy F. Christian, Raymond J Gibbons

Research output: Contribution to journalArticle

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Abstract

PURPOSE: To determine electrocardiographic features associated with myocardial salvage following reperfusion therapy in patients with inferior myocardial infarction. PATIENTS AND METHODS: Ninety-two consecutive patients with acute inferior myocardial infarction were treated with reperfusion therapy in a tertiary care center. Several features were measured on the presenting electrocardiogram, including the presence or absence of ST depression in the chest leads and the total magnitudes of ST elevation or depression, and were then evaluated for their association with myocardial salvage. Myocardial salvage (% of left ventricle) was the difference between myocardium at risk and final infarct size. Tomographic myocardial perfusion imaging with technetium-99m sestamibi was performed acutely to measure myocardium at risk and repeated prior to hospital discharge to measure final infarct size. RESULTS: The amount of myocardium at risk of infarction in the 92 patients was 19.1% ± 11.3% (range 1% to 68%), and the final infarct size was 10.6% ± 10.0% (range 0% to 45%). Thus, myocardial salvage in the 92 patients was 8.5% ± 8.4% (range - 11% to 35%) of the left ventricle, or 0.51 ± 0.38 (range 0.0 to 1.0) when expressed as a fraction of the myocardium at risk (salvage index). The presence or absence of anterior ST depression was the only one of seven electrocardiographic variables that was associated with myocardial salvage. Myocardial salvage was significantly greater in patients with anterior ST depression compared with those without it (10.6% ± 9.0% versus 5.9% ± 6.7%, P = 0.025). Myocardium at risk was significantly greater in patients with anterior ST depression compared with those without the depression (22.8% ± 12.2% versus 14.6% ± 8.3%, P = 0.0006), and infarct size tended to be larger (12.1% ± 10.4% versus 8.7% ± 9.4%, P = 0.10). Myocardial salvage as a fraction of the myocardium at risk (salvage index) was similar between the two patient groups (0.52 ± 0.37 versus 0.50 ± 0.39, P = NS). CONCLUSION: The presence of anterior ST depression during inferior myocardial infarction identifies a group of patients with the potential for greater myocardial salvage with reperfusion therapy. Such patients derive greater absolute benefit from reperfusion therapy because they have a larger amount of myocardium at risk, although their response to therapy (salvage index) is not intrinsically different.

Original languageEnglish (US)
Pages (from-to)5-11
Number of pages7
JournalAmerican Journal of Medicine
Volume104
Issue number1
DOIs
StatePublished - Jan 1998

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Inferior Wall Myocardial Infarction
Reperfusion
Myocardium
Therapeutics
Heart Ventricles
Technetium Tc 99m Sestamibi
Salvage Therapy
Myocardial Perfusion Imaging
Tertiary Care Centers
Infarction
Electrocardiography
Thorax

ASJC Scopus subject areas

  • Nursing(all)

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Association between anterior ST depression and increased myocardial salvage following reperfusion therapy in patients with inferior myocardial infarction. / Evans, Mark A.; Clements, Ian P.; Christian, Timothy F.; Gibbons, Raymond J.

In: American Journal of Medicine, Vol. 104, No. 1, 01.1998, p. 5-11.

Research output: Contribution to journalArticle

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abstract = "PURPOSE: To determine electrocardiographic features associated with myocardial salvage following reperfusion therapy in patients with inferior myocardial infarction. PATIENTS AND METHODS: Ninety-two consecutive patients with acute inferior myocardial infarction were treated with reperfusion therapy in a tertiary care center. Several features were measured on the presenting electrocardiogram, including the presence or absence of ST depression in the chest leads and the total magnitudes of ST elevation or depression, and were then evaluated for their association with myocardial salvage. Myocardial salvage ({\%} of left ventricle) was the difference between myocardium at risk and final infarct size. Tomographic myocardial perfusion imaging with technetium-99m sestamibi was performed acutely to measure myocardium at risk and repeated prior to hospital discharge to measure final infarct size. RESULTS: The amount of myocardium at risk of infarction in the 92 patients was 19.1{\%} ± 11.3{\%} (range 1{\%} to 68{\%}), and the final infarct size was 10.6{\%} ± 10.0{\%} (range 0{\%} to 45{\%}). Thus, myocardial salvage in the 92 patients was 8.5{\%} ± 8.4{\%} (range - 11{\%} to 35{\%}) of the left ventricle, or 0.51 ± 0.38 (range 0.0 to 1.0) when expressed as a fraction of the myocardium at risk (salvage index). The presence or absence of anterior ST depression was the only one of seven electrocardiographic variables that was associated with myocardial salvage. Myocardial salvage was significantly greater in patients with anterior ST depression compared with those without it (10.6{\%} ± 9.0{\%} versus 5.9{\%} ± 6.7{\%}, P = 0.025). Myocardium at risk was significantly greater in patients with anterior ST depression compared with those without the depression (22.8{\%} ± 12.2{\%} versus 14.6{\%} ± 8.3{\%}, P = 0.0006), and infarct size tended to be larger (12.1{\%} ± 10.4{\%} versus 8.7{\%} ± 9.4{\%}, P = 0.10). Myocardial salvage as a fraction of the myocardium at risk (salvage index) was similar between the two patient groups (0.52 ± 0.37 versus 0.50 ± 0.39, P = NS). CONCLUSION: The presence of anterior ST depression during inferior myocardial infarction identifies a group of patients with the potential for greater myocardial salvage with reperfusion therapy. Such patients derive greater absolute benefit from reperfusion therapy because they have a larger amount of myocardium at risk, although their response to therapy (salvage index) is not intrinsically different.",
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AU - Clements, Ian P.

AU - Christian, Timothy F.

AU - Gibbons, Raymond J

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N2 - PURPOSE: To determine electrocardiographic features associated with myocardial salvage following reperfusion therapy in patients with inferior myocardial infarction. PATIENTS AND METHODS: Ninety-two consecutive patients with acute inferior myocardial infarction were treated with reperfusion therapy in a tertiary care center. Several features were measured on the presenting electrocardiogram, including the presence or absence of ST depression in the chest leads and the total magnitudes of ST elevation or depression, and were then evaluated for their association with myocardial salvage. Myocardial salvage (% of left ventricle) was the difference between myocardium at risk and final infarct size. Tomographic myocardial perfusion imaging with technetium-99m sestamibi was performed acutely to measure myocardium at risk and repeated prior to hospital discharge to measure final infarct size. RESULTS: The amount of myocardium at risk of infarction in the 92 patients was 19.1% ± 11.3% (range 1% to 68%), and the final infarct size was 10.6% ± 10.0% (range 0% to 45%). Thus, myocardial salvage in the 92 patients was 8.5% ± 8.4% (range - 11% to 35%) of the left ventricle, or 0.51 ± 0.38 (range 0.0 to 1.0) when expressed as a fraction of the myocardium at risk (salvage index). The presence or absence of anterior ST depression was the only one of seven electrocardiographic variables that was associated with myocardial salvage. Myocardial salvage was significantly greater in patients with anterior ST depression compared with those without it (10.6% ± 9.0% versus 5.9% ± 6.7%, P = 0.025). Myocardium at risk was significantly greater in patients with anterior ST depression compared with those without the depression (22.8% ± 12.2% versus 14.6% ± 8.3%, P = 0.0006), and infarct size tended to be larger (12.1% ± 10.4% versus 8.7% ± 9.4%, P = 0.10). Myocardial salvage as a fraction of the myocardium at risk (salvage index) was similar between the two patient groups (0.52 ± 0.37 versus 0.50 ± 0.39, P = NS). CONCLUSION: The presence of anterior ST depression during inferior myocardial infarction identifies a group of patients with the potential for greater myocardial salvage with reperfusion therapy. Such patients derive greater absolute benefit from reperfusion therapy because they have a larger amount of myocardium at risk, although their response to therapy (salvage index) is not intrinsically different.

AB - PURPOSE: To determine electrocardiographic features associated with myocardial salvage following reperfusion therapy in patients with inferior myocardial infarction. PATIENTS AND METHODS: Ninety-two consecutive patients with acute inferior myocardial infarction were treated with reperfusion therapy in a tertiary care center. Several features were measured on the presenting electrocardiogram, including the presence or absence of ST depression in the chest leads and the total magnitudes of ST elevation or depression, and were then evaluated for their association with myocardial salvage. Myocardial salvage (% of left ventricle) was the difference between myocardium at risk and final infarct size. Tomographic myocardial perfusion imaging with technetium-99m sestamibi was performed acutely to measure myocardium at risk and repeated prior to hospital discharge to measure final infarct size. RESULTS: The amount of myocardium at risk of infarction in the 92 patients was 19.1% ± 11.3% (range 1% to 68%), and the final infarct size was 10.6% ± 10.0% (range 0% to 45%). Thus, myocardial salvage in the 92 patients was 8.5% ± 8.4% (range - 11% to 35%) of the left ventricle, or 0.51 ± 0.38 (range 0.0 to 1.0) when expressed as a fraction of the myocardium at risk (salvage index). The presence or absence of anterior ST depression was the only one of seven electrocardiographic variables that was associated with myocardial salvage. Myocardial salvage was significantly greater in patients with anterior ST depression compared with those without it (10.6% ± 9.0% versus 5.9% ± 6.7%, P = 0.025). Myocardium at risk was significantly greater in patients with anterior ST depression compared with those without the depression (22.8% ± 12.2% versus 14.6% ± 8.3%, P = 0.0006), and infarct size tended to be larger (12.1% ± 10.4% versus 8.7% ± 9.4%, P = 0.10). Myocardial salvage as a fraction of the myocardium at risk (salvage index) was similar between the two patient groups (0.52 ± 0.37 versus 0.50 ± 0.39, P = NS). CONCLUSION: The presence of anterior ST depression during inferior myocardial infarction identifies a group of patients with the potential for greater myocardial salvage with reperfusion therapy. Such patients derive greater absolute benefit from reperfusion therapy because they have a larger amount of myocardium at risk, although their response to therapy (salvage index) is not intrinsically different.

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