RAPID REDUCTION OF ST-SEGMENT ELEVATION AFTER SUCCESSFUL DIRECT ANGIOPLASTY IN ACUTE MYOCARDIAL-INFARCTION

The aim of this study was to evaluate whether assessment of ST-segment changes in the 12-lead electrocardiogram from admission to 30 minutes after successful direct coronary angioplasty can predict myocardial d amage and functional outcome in patients with acute myocardial infarct ion (AMI). Of 158 consecutive patients, 117 (92 men, aged 61 +/- 11 ye ars) were prospectively classified into 2 groups: group 1, <50% reduct ion in ST-segment elevation in a single selected lead (42 patients); g roup 2, greater than or equal to 50% reduction in ST-segment elevation (75 patients). Baseline characteristics were similar except for anter ior wall AMI and Killip class >2, which were more prevalent in group 1 . Peak creatine kinase was significantly higher in group 1 (3,690 +/- 2,809 vs 2,592 +/- 1,960 U/L; p = 0.018). One-month echocardiograms we re obtained in 102 patients (87%). Infarct zone wall motion score inde x decreased in both groups, but this reduction was higher in group 2 ( p <0.001). Functional recovery (>0.22 decrease in infarct zone wall mo tion score index) was observed in 34% of group 1 and in 78% of group 2 patients (p<0.001). One-month left ventricular ejection fraction was higher in group 2 (p <0.001). At multivariate analysis, reduction of S T-segment elevation was the only independent predictor of functional r ecovery (p <0.001). In conclusion, ST-segment analysis provides rapid and inexpensive information allowing identification of patients who ar e likely to benefit the most from myocardial reperfusion as early as 3 0 minutes after the last balloon inflation. (C) 1997 by Excerpta Medic a, Inc.