P. Clemmensen et al., IMPACT OF INFARCT ARTERY PATENCY ON THE RELATIONSHIP BETWEEN ELECTROCARDIOGRAPHIC AND VENTRICULOGRAPHIC EVIDENCE OF ACUTE MYOCARDIAL-ISCHEMIA, European heart journal, 15(10), 1994, pp. 1356-1361
Routine invasive evaluations are being abandoned, and thus simple non-
invasive methods for estimating the extent of jeoparized myocardium du
ring evolving myocardial infarction are needed for risk stratification
to guide the appropriate therapeutic intervention. With this in mind
the aim of the paper was to evaluate the association between ischaemic
changes in the standard electrocardiogram and the function of acutely
infarcted myocardium in relation to infarct artery patency status. Fo
rty consecutive patients with a first acute myocardial infarction, adm
itted within 6 h of symptom onset and without bundle branch or fascicu
lar block were included. Summated ST segment elevation in 11 electroca
rdiographic leads (aVR) excluded) was measured to the nearest 0.05 mV
and compared to regional wall motion, estimated by the centreline meth
od (SD/chord) and global left ventricular ejection fraction (% LVEF) a
fter thrombolytic therapy. Acute angiographic and ST segment measureme
nts were performed at a median 254 min (range 70-485) after the onset
of symptoms. Patients were grouped according to infarct artery patency
status after intravenous thrombolysis. Of the 40 patients, 27 had a p
atent (Thrombolysis In Acute Myocardial Infarction trial (TIMI) grade
2-3 flow) and 13 had persistently occluded (TIMI 0-1 flow) infarct art
eries. Anterior myocardial infarction was present in 13 and seven pati
ents in the two groups. In the TIMI 2-3 group, the summated ST elevati
on did not correlate with % LVEF or SD/chord (r(s) = -0.8; and r(s) =
-0.17, respectively). In the TIMI0-1 group the summated ST elevation c
orrelated inversely with both % LVEF and SD/chord (r(s) = -0.70; and r
(s) = 0.56, respectively). These results show that acute summated ST s
egment elevation correlates with both global and regional left ventric
ular function in patients with persistently occluded infarct arteries,
thus providing a non-invasive method for estimating the amount of jeo
pardized myocardium.