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Early Electrocardiographic Findings and MR Imaging-Verified Microvascular Injury and Myocardial Infarct Size

Robin Nijveldt, MD, PhD^_*,,_*, Pieter A. van der Vleuten, MD, Alexander Hirsch, MD^,, Aernout M. Beek, MD^_*, René A. Tio, MD, PhD, Jan G.P. Tijssen, PhD, Jan J. Piek, MD, PhD, Albert C. van Rossum, MD, PhD^_*,, Felix Zijlstra, MD, PhD

^_* Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
Academic Medical Center, Amsterdam, the Netherlands

^_* Reprint requests and correspondence: Dr. Robin Nijveldt, Department of Cardiology, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands (Email: r.nijveldt{at}vumc.nl).

Objectives: This study investigated early electrocardiographic findings in relation to left ventricular (LV) function, extent and size of infarction, and microvascular injury in patients with acute myocardial infarction (MI) treated with percutaneous coronary intervention (PCI).

Background: The electrocardiogram (ECG) is the most used and simplest clinical method to evaluate the risk for patients immediately after reperfusion therapy for acute MI. ST-segment resolution and residual ST-segment elevation have been used for prognosis in acute MI, whereas Q waves are related to outcome in chronic MI. We hypothesized that the combination of these electrocardiographic measures early after primary PCI would enhance risk stratification.

Methods: We prospectively included 180 patients with a first acute ST-segment elevation MI to assess ST-segment resolution, residual ST-segment elevation, and number of Q waves using the 12-lead ECG acquired on admission and 1 h after successful PCI. The ECG findings were related to LV function, infarction size and transmurality, and microvascular injury as assessed with cine and gadolinium-enhanced cardiac magnetic resonance 4 ± 2 days after reperfusion therapy.

Results: Residual ST-segment elevation (β = –2.00, p = 0.004) and the number of Q waves (β = –1.66, p = 0.005) were independent ECG predictors of LV ejection fraction. Although the number of Q waves was the only independent predictor of infarct size (β = 2.01, p < 0.001) and transmural extent of infarction (β = 0.60, p < 0.001), residual ST-segment elevation was the only independent predictor of microvascular injury (odds ratio: 19.1, 95% confidence interval: 2.4 to 154, p = 0.005) in multivariable analyses. The ST-segment resolution was neither associated with LV function, infarct size, or transmurality indexes, nor with microvascular injury in multivariable analysis.

Conclusions: In patients after successful coronary intervention for acute MI, residual ST-segment elevation and the number of Q waves on the post-procedural ECG offer valuable complementary information on prediction of myocardial function and necrosis and its microvascular status.

Key Words: electrocardiography • cardiac magnetic resonance • myocardial infarction • left ventricular function

Abbreviations and Acronyms   CMR = cardiac magnetic resonance   ECG = electrocardiogram/electrocardiography   LGE = late gadolinium enhancement   LV = left ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESV = left ventricular end-systolic volume   MI = myocardial infarction   MBG = myocardial blush grading   MVO = microvascular obstruction   OR = odds ratio   PCI = percutaneous coronary intervention   TIMI = Thrombolysis In Myocardial Infarction

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