Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2019;72:120-9 - Vol. 72 Num.02 DOI: 10.1016/j.rec.2018.01.005

Clinical Significance of Reciprocal ST-segment Changes in Patients With STEMI: A Cardiac Magnetic Resonance Imaging Study

Ji-Won Hwang a, Jeong Hoon Yang b,c, Young Bin Song b,, Taek Kyu Park b, Joo Myung Lee b, Ji-Hwan Kim d, Woo Jin Jang e, Seung-Hyuk Choi b, Joo-Yong Hahn b, Jin-Ho Choi b, Joonghyun Ahn f, Keumhee Carriere g, Sang Hoon Lee b, Hyeon-Cheol Gwon b

a Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
b Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
c Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
d Division of Cardiology, Department of Medicine, Namyangju Baek Hospital, Namtangju, Republic of Korea
e Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
f Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
g Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada

Keywords

ST-segment elevation myocardial infarction. Reciprocal change of electrocardiogram. Area at risk. Cardiac magnetic resonance imaging.

Abstract

Introduction and objectives

We sought to determine the association of reciprocal change in the ST-segment with myocardial injury assessed by cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Methods

We performed CMR imaging in 244 patients who underwent primary PCI for their first STEMI; CMR was performed a median 3 days after primary PCI. The first electrocardiogram was analyzed, and patients were stratified according to the presence of reciprocal change. The primary outcome was infarct size measured by CMR. Secondary outcomes were area at risk and myocardial salvage index.

Results

Patients with reciprocal change (n = 133, 54.5%) had a lower incidence of anterior infarction (27.8% vs 71.2%, P < .001) and shorter symptom onset to balloon time (221.5 ± 169.8 vs 289.7 ± 337.3 min, P = .042). Using a multiple linear regression model, we found that patients with reciprocal change had a larger area at risk (P = .002) and a greater myocardial salvage index (P = .04) than patients without reciprocal change. Consequently, myocardial infarct size was not significantly different between the 2 groups (P = .14). The rate of major adverse cardiovascular events, including all-cause death, myocardial infarction, and repeat coronary revascularization, was similar between the 2 groups after 2 years of follow-up (P = .92).

Conclusions

Reciprocal ST-segment change was associated with larger extent of ischemic myocardium at risk and more myocardial salvage but not with final infarct size or adverse clinical outcomes in STEMI patients undergoing primary PCI.

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1885-5857/© 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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