RELATION BETWEEN ST-SEGMENT CHANGES AND MYOCARDIAL PERFUSION EVALUATED BY MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION TREATED WITH DIRECT ANGIOPLASTY

The aim of this study was to evaluate the relation between myocardial perfusion and ST-segment changes in patients with acute myocardial inf arction treated with successful direct angioplasty. Thirty-seven patie nts, successfully treated with direct angioplasty, underwent myocardia l contrast echocardiography before and after angioplasty. The sum of S T-segment elevation divided by the number of the leads involved (ST-se gment elevation index) was calculated at 1, 5, 10, 20, and 30 minutes after restoration of a Thrombolysis In Myocardial Infarction trial gra de 3 flow. After recanalization, myocardial reperfusion within the ris k area was observed in 26 patients, whereas a no-reflow phenomenon occ urred in 11. In patients with myocardial reperfusion, the ST-segment e levation index progressively declined, whereas in patients with no ref low, no significant change was observed. Reduction of greater than or equal to 50% in the ST-segment elevation index occurred in 20 of the 2 6 patients with reflow and in 1 of the 11 with no reflow (p = 0.0002). An additional increase of greater than or equal to 30% in the ST-segm ent elevation index occurred in 3 patients with reflow and in 7 with n o reflow (p = 0.003). Sensitivity, specificity, positive and negative predictive values, and accuracy of the reduction in the ST-segment ele vation index for predicting microvascular reflow were 77%, 91%, 95%, 6 2%, and 81%, respectively. The corresponding values of the increase in ST-segment elevation index for predicting no reflow were 64%, 88%, 70 %, 85%, and 81%, respectively. In conclusion, after successful angiopl asty, different patterns of myocardial perfusion are associated with d ifferent ST-segment changes. Analysis of ST-segment changes predicts t he degree of myocardial reperfusion. (C) 1998 by Excerpta Medica, Inc.