Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty

Therese Billgren, C Maynard, TF Christian, MA Rahman, M Saeed, SC Hammill, GS Wagner, Y Birnbaum

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Among patients with ST-elevation acute myocardial infarction, those with terminal QRS distortion (grade 3 ischemia) have higher mortality and larger infarct size (IS) than patients without QRS distortion (grade 2 ischemia). Methods: We assessed the relation of baseline electrocardiographic ischemia grades to area at risk (AR) and myocardial salvage [100 (AR - IS)/AR] in 79 patients who underwent primary angioplasty for first ST-elevation acute myocardial infarction and had technetium Tc 99m sestamibi single-photon emission computed tomography before angioplasty (AR) and at predischarge (IS). Patients were classified as having grade 2 ischemia (ST elevation without terminal QRS distortion in any of the leads, n = 48), grade 2.5 ischemia (ST elevation with terminal QRS distortion in 1 lead, n = 16), or grade 3 ischemia (ST elevation with terminal QRS distortion in > 2 adjacent leads, n = 15). Results: Time to treatment was comparable among groups. AR was comparable among groups (38% +/- 20%, 33% +/- 23%, and 34% +/- 23%, respectively; P = .70). There were no differences among groups in residual myocardial perfusion (severity index 0.28 +/- 0.12, 0.29 +/- 0.16, and 0.30 +/- 0.15 in grades 2, 2.5, and 3 ischemia, respectively; P = .97). In contrast, there was a trend toward lower myocardial salvage (45% +/- 32%) in the grade 3 group than in the grade 2 (65% +/- 33%) and grade 2.5 (65% +/- 40%) groups (P = .16). Salvage was dependent on time only in the grade 3 group. Spearman rank correlation coefficients between time to treatment and percentage salvage were 0.003 (P = .99), -0.24 (P = .38), and -0.63 (P = .022) for grades 2, 2.5, and 3, respectively. Conclusions: Patients with grade 3 ischemia have rapid progression of necrosis over time and less myocardial salvage. This admission pattern is a predictor of myocardial salvage by primary angioplasty.
Original languageEnglish
Pages (from-to)187-194
JournalJournal of Electrocardiology
Volume38
Issue number3
DOIs
Publication statusPublished - 2005

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Free keywords

  • infarct size
  • acute myocardial infarction
  • electrocardiography
  • risk
  • area at

Fingerprint

Dive into the research topics of 'Grade 3 ischemia on the admission electrocardiogram predicts rapid progression of necrosis over time and less myocardial salvage by primary angioplasty'. Together they form a unique fingerprint.

Cite this