(Circulation. 1999;99:1972-1977.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Determinants and Prognostic Implications of Persistent ST-Segment Elevation After Primary Angioplasty for Acute Myocardial Infarction
Importance of Microvascular Reperfusion Injury on Clinical Outcome
From the Departments of Cardiology (M.J.C., J.B., L.V., C.J.V.) and Intensive Care (P.J., H.D.R.), Antwerp University Hospital, Edegem, Belgium.
Correspondence to Marc Claeys, MD, PhD, Division of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium. E-mail mclaeys{at}uia.ua.ac.be
Background—Despite early recanalization of an occluded infarct artery, reperfusion at the level of the microcirculation may remain impaired owing to a process of microvascular reperfusion injury.
Methods and Results—Microvascular reperfusion injury was studied
in 91 patients with acute myocardial infarction (AMI) by evaluation of
the resolution of ST-segment elevation after successful PTCA.
Impaired microvascular reperfusion, defined as the presence of
persistent (
50% of initial value) ST-segment elevation (ST 50%)
at the end of coronary intervention, was observed in 33
patients (36%) and was independently correlated with low
systolic pressure on admission and high age. Patients 55
years of age with systolic pressures 
120 mm Hg were at
high risk for development of impaired reperfusion compared with
patients not meeting these criteria (72% versus 14%,
P<0.001). Impaired microvascular reperfusion was
associated with a more extensive infarction and worse clinical outcome
at the 1-year follow-up: cardiac death rate, 15% versus 2% (ST 50%
versus ST <50%, P=0.01); nonfatal MI rate, 9% versus
2% (P=0.1); and total major adverse cardiac event
(MACE) rate, 45% versus 15% (P<0.005). ST 50% was
the most important independent determinant of MACE with an adjusted
risk ratio of 3.4.
Conclusions—Impaired microvascular reperfusion, as evidenced by
ST 50% after successful recanalization, occurs
in more than one third of our AMI patients, especially in older
patients with low systolic pressure. Its detrimental
implications on clinical outcome reinforce the need to develop
adjunctive agents that attenuate the process of reperfusion injury.
Key Words: reperfusion • infarction • angioplasty
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