Significance of additional ST segment elevation in patients with no reflow after angioplasty for acute myocardial infarction.

Objectives: We sought to evaluate the incidence, timing, and clinical significance of additional increase in ST segment elevation (ST-SE) in patients showing no reflow after angioplasty for acute myocardial infarction.

Methods: We studied 26 patients with acute myocardial infarction showing myocardial contrast echocardiography no reflow after successful angioplasty. Baseline and 6-month 2-dimensional echocardiograms were obtained in 21 surviving patients.

Results: After angioplasty, 13 patients showed greater than 30% additional increase in ST-SE (group 1), whereas 13 did not (group 2). Baseline clinical, echographic, and angiographic characteristics, and 6-month patency and restenosis rate, were similar between the two groups. From baseline to 6 months, a similar global and regional systolic function was found between the two groups, whereas a higher increase in left ventricular end-diastolic volume occurred in group 1 (135 +/- 45 vs 168 +/- 42 mL, P = .033). The additional increase in ST-SE was not associated with more severe microvascular damage (myocardial contrast echocardiography score index: 0.14 +/- 0.26 vs 0.22 +/- 0.27), higher peak creatine kinase value (4888 +/- 2533 vs 3109 +/- 2055 U/L, P = .061), higher incidence of left ventricular remodeling (73% vs 60%, P = .537), or worse outcome (26 +/- 24 months) such as death (15% vs 23%, P = .619), hospitalization for heart failure (8% vs 23%, P = .277), or reinfarction (8% vs 0%, P = .308).

Conclusions: Our data show that in patients showing no reflow after angioplasty a transient additional increase in ST-SE occurs in half of patients. The prognostic value of additional increase in ST-SE remains uncertain in the era of primary angioplasty.