COMPARISON OF PATIENTS WITH ANTERIOR WALL HEALED MYOCARDIAL-INFARCTION WITH AND WITHOUT EXERCISE-INDUCED ST-SEGMENT ELEVATION

To assess the extent of myocardial necrosis and ischemia in patients w ith anterior wall healed myocardial infarction depending on whether ST -segment elevation was present on precordial leads during exercise tes ting, 62 consecutive patients (49 men and 13 women, age [mean +/- SD] 56 +/- 11 years) with anterior wall infarcts were assessed with exerci se technetium-99m (Tc-99m) methoxy-isobutyl-isonitrile single-photon e mission computed tomography and quantification of the extent of necros is and ischemia on polar maps: 22 patients had greater than or equal t o 1 mm ST-segment elevation during exercise, and 40 did not. The exten t of the necrosis in the anteroseptal (p = 0.001) and apical (p = 0.00 2) regions, the extent of ischemia in the lateral region (p = 0.003) o n polar maps, and the frequency of ventricular aneurysm as shown by ca rdiac catheterization (p = 0.001) were significantly greater in patien ts with ST-segment elevation. In a multiple logistic regression model, both extent of necrosis in the anteroseptal region (odds ratio 10.8; 95% confidence interval 2.7 to 44.0) and extent of ischemia in the lat eral region (odds ratio 7.25; 95% confidence interval 1.6 to 32.7) wer e associated with exercise-induced ST-segment elevation. These data su ggest that ST-segment elevation in anterior infarctions is associated with wider necrosis in the anteroseptal and apical regions, with a wid er extent of ischemia in the lateral region and a higher frequency of ventricular aneurysm. Consequently, it cannot be used as a marker of v iability. (C) 1998 by Excerpta Medica, Inc.