Skip to main content
NCBI home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2006 Dec 5;27(2):106–111. doi: 10.1002/clc.4960270216

Relation of lateral ST‐segment elevation pattern to myocardial salvage in patients with recanalized anterolateral acute myocardial infarction

Masami Kosuge 1, Kazuo Kimura 1,✉, Toshiyuki Ishikawa 1, Tsutomu Endo 1, Teruyasu Sugano 1, Takeshi Nakagawa 1, Kiyoshi Hibi 1, Tomoyori Nakatogawa 1, Jyunn Okuda 1, Noritaka Toda 1, Kengo Tsukahara 1, Takeshi Takamura 1, Yoshio Tahara 1, Satoshi Umemura 1
PMCID: PMC6654472  PMID: 14979634

Abstract

Background: Although anterior acute myocardial infarction (AMI) with ST‐segment elevation in lateral leads is associated with a poor prognosis, the significance of the pattern of lateral ST‐segment elevation has not been examined.

Hypothesis: The aim of the study was to examine the relation of the pattern of lateral ST‐segment elevation to myocardial reperfusion and infarct size in patients with AMI.

Methods: We studied 111 patients who had a first AMI presenting with anterolateral ST‐segment elevation and Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow of the left anterior descending coronary artery within 6 h from symptom onset. Patients were classified into two groups according to the pattern of lateral ST‐segment elevation on the admission electrocardiogram: Group 1, 42 patients with equivalent or greater ST‐segment elevation in lead I than in lead aVL, and Group 2, 69 patients with lesser ST‐segment elevation in lead I in than in lead aVL. Left ventricular ejection fraction (LVEF) was measured by predischarge left ventriculography.

Results: There were no differences between the two groups in age, gender, time from onset to recanalization, culprit lesion, or collateral development. Group 1 patients had a higher probability of impaired myocardial reperfusion as indicated by a myocardial blush grade of 0 or 1 after recanalization, a higher peak creatine kinase level, and a lower LVEF than Group 2 patients (p = 0.0001, respectively).

Conclusions: We conclude that equivalent or greater ST‐segment elevation in lead I than in lead aVL is associated with impaired myocardial reperfusion and less myocardial salvage in patients with recanalized AMI who present with anterolateral ST‐segment elevation on the admission electrocardiogram.

Keywords: acute myocardial infarction, ST‐segment, reperfusion

Full Text

The Full Text of this article is available as a PDF (82.7 KB).

References

  • 1. The Multicenter Postinfarction Research Group : Risk stratification and survival after myocardial infarction. N Engl J Med 1983; 309: 331–336 [DOI] [PubMed] [Google Scholar]
  • 2. Jugdutt BI, Hutchin GM, Bulkley BH, Becker LC: Myocardial infarction in the conscious dog: Three‐dimensional mapping of infarct, collateral flow and region at risk. Circulation 1979; 60: 1141–1150 [DOI] [PubMed] [Google Scholar]
  • 3. Christian TF, Schwartz RS, Gibbons RJ: Determinants of infarct size in reperfusion therapy for acute myocardial infarction. Circulation 1992; 96: 81–90 [DOI] [PubMed] [Google Scholar]
  • 4. Kloner RA, Shook T, Antman EM, Cannon CP, Przyklenk K, Yoo K, McCabe CH, Braunwald E, and the TIMI‐9B investigators : Prospective temporal analysis of the onset of preinfarction angina versus outcome. Circulation 1998; 97: 1042–1045 [DOI] [PubMed] [Google Scholar]
  • 5. Nakagawa Y, Ito H, Kitakaze M, Kusuoka H, Hori M, Kuzuya T, Higashino Y, Fujii K, Minamino T: Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction: Retrospective clinical evidence of preconditioning. J Am Coll Cardiol 1995; 25: 1076–1083 [DOI] [PubMed] [Google Scholar]
  • 6. Yoshino H, Kachi E, Shimizu H, Taniuchi M, Yano K, Udagawa H, Kajiwara T, Shimoyama K, Ishikawa K: Severity of residual stenosis of infarct‐related lesion and left ventricular function after single‐vessel anterior wall myocardial infarction: Implication of ST‐segment elevation in lead aVL of the admission electrocardiograms. Clin Cardiol 2000; 23: 175–180 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Udagawa H, Yoshino H, Kachi E, Taniuti M, Yotsukura M, Ishikawa K: ST‐segment elevation in leads I and aVL predicts short‐term prognosis in acute anterior wall myocardial infarction. Am J Cardiol 2000; 85: 101–104 [DOI] [PubMed] [Google Scholar]
  • 8. Van't Hof AWJ, Liem A, de Boer M, Zijilstra F, for the Zwolle Myocardial Infarction Study Group : Clinical value of 12‐lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction. Lancet 1997; 350: 615–619 [DOI] [PubMed] [Google Scholar]
  • 9. Van't Hof AWJ, Liem A, Suryapranata H, Hoorntje JCA, de Boer M, Zijilstra F: Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction. Circulation 1998; 97: 2302–2306 [DOI] [PubMed] [Google Scholar]
  • 10. Andrews J, Straznicky IT, French JK, Green CL, Maas ACP, Lund M, Krucoff MW, White HD, for the HERO‐1 investigators : ST‐segment recovery adds to the assessment of TIMI 2 and 3 flow in predicting infarct wall motion after thrombolytic therapy. Circulation 2000; 101: 2138–2143 [DOI] [PubMed] [Google Scholar]
  • 11. Ito H, Maruyama A, Iwakura K, Takiuchi S, Masuyama T, Hori M, Higashino Y, Fujii K, Minamino T: Clinical implication of the “no‐reflow” phenomenon. Circulation 1996; 93: 223–228 [DOI] [PubMed] [Google Scholar]
  • 12. Wu K, Zerhouni EA, Judd RM, Lugo‐Olivieri CH, Barouch LA, Schulman SP, Blumenthal RS, Lima JAC: Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998; 97: 765–772 [DOI] [PubMed] [Google Scholar]
  • 13. The TIMI Study Group : The Thrombolysis in Myocardial Infarction (TIMI) trial: Phase I findings. N Engl J Med 1985; 312: 932–936 [DOI] [PubMed] [Google Scholar]
  • 14. Rentrop KP, Cohen M, Blanke H, Philip RA: Change in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985; 5: 587–592 [DOI] [PubMed] [Google Scholar]
  • 15. Aldrich HR, Wagner NB, Boswick J, Corsa A, Jones MG, Grande P, Lee KL, Wagner GS: Use of initial ST‐segment deviation for prediction of final electrocardiographic size of acute myocardial infarction. Am J Cardiol 1988; 61: 749–753 [DOI] [PubMed] [Google Scholar]
  • 16. Selvester RH, Wagner GS, Hindman NB: The Selvester QRS scoring system for estimating myocardial infarct size. The development and application of the system. Arch Intern Med 1985; 145: 1877–1881 [PubMed] [Google Scholar]
  • 17. Juergens C, Femandes C, Hasche E, Meikle S, Bautovich G, Currie C, Freedman S, Jeremey R: Electrocardiographic measurement of infarct size after thrombolytic therapy. J Am Coll Cardiol 1996; 27: 617–624 [DOI] [PubMed] [Google Scholar]
  • 18. Miida T, Oda H, Toeda T, Higuma N: Additional ST‐segment elevation immediately after reperfusion and its effect on myocardial salvage in anterior wall acute myocardial infarction. Am J Cardiol 1994; 73: 851–855 [DOI] [PubMed] [Google Scholar]
  • 19. Feldman LJ, Himbert D, Juliard J, Karrillon G, Benamer H, Aubry P, Boudvillian O, Seknadji P, Faraggi M, Steg G: Reperfusion syndrome: Relationship of coronary blood flow reserve to left ventricular function and infarct size. J Am Coll Cardiol 2000; 35: 1162–1169 [DOI] [PubMed] [Google Scholar]
  • 20. Sandler H, Dodge HT: The use of single plane angiocardiograms for the calculation of left ventricular volume in man. Am Heart J 1968; 75: 325–334 [DOI] [PubMed] [Google Scholar]
  • 21. Sheehan FH, Bolson EL, Dodge HT, Mathey DG, Schofer J, Woo HW: Advantages and applications of the centerline method for characterizing regional ventricular function. Circulation 1986; 74: 293–305 [DOI] [PubMed] [Google Scholar]
  • 22. Willems JL, Willems RJ, Willems GM, Arnold AER, vande Werf F, Verstraeter M, for the European Cooperative Study Group for Recombinant Tissue‐Type Plasminogen Activator : Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. Circulation 1990; 82: 1147–1158 [DOI] [PubMed] [Google Scholar]
  • 23. Birnbaum Y, Sclarovsky S, Solodky A, Tschori J, Herz I, Sulkes J, Mager A, Rechavia E: Prediction of the level of the left anterior descending coronary artery obstruction during anterior wall acute myocardial infarction by admission electrocardiogram. Am J Cardiol 1993; 72: 823–826 [DOI] [PubMed] [Google Scholar]
  • 24. Grant RP: Clinical Electrocardiography. The Spatial Vector Approach. New York, Toronto, London: McGraw Hill Book Company, 1957. [Google Scholar]
  • 25. Iwakura K, Ito H, Kawano S, Shintani Y, Yamamoto K, Kato A, Ikushima M, Tanaka K, Kitakaze M, Hori M, Higashino Y, Fujii K: Predictive factors for development of the no‐reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction. J Am Coll Cardiol 2001; 38: 472–477 [DOI] [PubMed] [Google Scholar]
  • 26. de Lemos JA, Antman EM, Gibson M, McCabe CH, Giugliano RP, Murphy SA, Coutler SA, Anderson RP, Scherer J, Van der Wieken R, Van de Werf Fans, Braunwald E, for the TIMI 14 investigators : Abciximab improves both epicardial flow and myocardial reperfusion in ST‐elevation myocardial infarction. Circulation 2000; 101: 239–243 [DOI] [PubMed] [Google Scholar]
  • 27. Marzilli M, Orsini E, Marraccini P, Testa R: Beneficial effects of intracoronary adenosine as an adjunctive to primary angioplasty in acute myocardial infarction. Circulation 2000; 101: 2154–2159 [DOI] [PubMed] [Google Scholar]
  • 28. Ito H, Taniyama Y, Iwakura K, Nishikawa N, Masuyama T, Kuzuya T, Higashino Y, Fujii K, Minamino T: Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol 1999; 33: 654–660 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES