Grade III ischemia on presentation with acute myocardial infarction predicts rapid progression of necrosis and less myocardial salvage with thrombolysis

Yochai Birnbaum, Kenneth W. Mahaffey, Douglas A. Criger, Kathy B. Gates, Gabriel I. Barbash, Alejandro Barbagelata, Peter Clemmensen, Elena B. Sgarbossa, Raymond J. Gibbons, M. Atiar Rahman, Robert M. Califf, Christopher B. Granger, Galen S. Wagner

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

We assessed the relation between baseline electrocardiographic ischemia grades and initial myocardial area at risk (AR) and final infarct size (IS) in 49 patients who had undergone 99mTc sestamibi single-photon emission computed tomography before and 6 ± 1 days after thrombolysis. Patients were classed as having grade III ischemia (ST segment elevation with terminal QRS distortion, n = 19) or grade II ischemia (ST elevation but no terminal QRS distortion, n = 30). We compared AR and IS by baseline ischemia grade and treatment (adenosine vs. placebo) and assessed relations of infarction index (IS/AR ratio × 100) to time to thrombolysis, baseline ischemia grade, and adenosine therapy. Time to thrombolysis was similar for grade II and grade III. For placebotreated patients, the median AR did not differ significantly between grade II (38%) and grade III patients (46%, p = 0.47), nor did median IS (16 vs. 40%, p = 0.096), but the median infarction index was 66 vs. 90% (p = 0.006). For adenosine-treated patients, median AR (21 vs. 26%, p = 0.44), median IS (5 vs. 17%, p = 0.15), and their ratio (31 vs. 67%, p = 0.23) did not differ significantly between grade II and grade III patients. The infarction index independently related to grade III ischemia (p = 0.0121) and adenosine therapy (p = 0.045). Infarct size related to baseline ischemia grade and was reduced by adenosine treatment. Necrosis progressed slowlier with baseline grade II versus III ischemia, which could offer more time for myocardial salvage with reperfusion.

Original languageEnglish (US)
Pages (from-to)166-174
Number of pages9
JournalCardiology
Volume97
Issue number3
DOIs
StatePublished - Jul 2 2002

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Keywords

  • Acute MI
  • Area at risk
  • Electrocardiography
  • Infarct size

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Birnbaum, Y., Mahaffey, K. W., Criger, D. A., Gates, K. B., Barbash, G. I., Barbagelata, A., Clemmensen, P., Sgarbossa, E. B., Gibbons, R. J., Rahman, M. A., Califf, R. M., Granger, C. B., & Wagner, G. S. (2002). Grade III ischemia on presentation with acute myocardial infarction predicts rapid progression of necrosis and less myocardial salvage with thrombolysis. Cardiology, 97(3), 166-174. https://doi.org/10.1159/000063334