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Terenicheva MA, Shakhnovich RM, Stukalova OV, Pevzner DV, Arutyunyan GK, Demchenkova AY, Merkulova IN, Ternovoy SK. Correlations between clinical and laboratory findings and prognostically unfavorable CMR-based characteristics of acute ST-elevation myocardial infarction. ACTA ACUST UNITED AC 2021; 61:44-51. [PMID: 33734055 DOI: 10.18087/cardio.2021.1.n1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate factors associated with unfavorable predictive characteristics of ST-segment elevation acute myocardial infarction (STEMI) as per data of magnetic resonance imaging (MRI).Material and methods The study included 52 patients with STEMI who underwent a primary percutaneous coronary intervention (pPCI). Contrast-enhanced cardiac MRI was performed for all patients on days 3-7. Delayed contrast-enhancement images were used for assessing infarct size, presence of microvascular obstruction (MVO) areas, and heterogeneity zones.Results Multifactorial analysis showed that independent predictors of MVO were type 2 diabetes mellitus (DM) (relative risk (RR) 1.9, confidence interval (CI): 1.1-3.26, р=0.012), increased levels of brain natriuretic peptide (BNP) (RR 2.04, CI: 1.39-2.99, р=0.004) and creatine kinase (CK) (RR 2.06, CI: 0.52-0.80, р=0.02), and infarct size (IS) (RR 2.81; CI: 1.38-5.72, р=0.0004). Construction of ROC curves provided the quantitative values of study indexes, at which the risk of MVO increased. For BNP, this value was ≥276 pg/ml (sensitivity, 95.7 %; specificity, 37.9 %); for CK ≥160 U/l (sensitivity, 74.1 %; specificity, 61.9 %); and for IS ≥18.8 % (sensitivity, 79.3 %; specificity, 69.6 %). Correlation analysis of risk factors for increased size of the heterogeneity zone showed significant correlations of the heterogeneity zone size with older age of patients (r=0.544, р<0.0001), higher concentrations of BNP (r=0.612, р<0.0001), CK (r=0.3, 95 % CI: 0.02-0.5, р=0.03), and C-reactive protein (CRP) (r=0.59, CI: 0.3-0.7, р=0.0001). Increased levels of CK (r=0.53, 95 % CI: 0.29-0.70, р=0.0001) and BNP (r=0.55, 95 % CI: 0.28-0.70, p=0.0003) significantly correlated with increased IS.Conclusion Risk of MVO formation as per MRI data increased in the presence of type 2 DM and IS ≥18.8 % (р<0.05). Formation of MVO in patients with STEMI was associated with increased levels of BNP ≥276 pg/ml and CK ≥160 U/l (р<0.05). Increased levels of BNP, CK, and CRP were associated with a larger size of heterogeneity zone according to data of the correlation analysis. A larger heterogeneity zone was more typical for older patients. Increased levels of CK and BNP were also associated with larger IS. The correlation analysis did not show any significant interactions between the size of heterogeneity zone, IS, and MVO size (р>0.05).
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Affiliation(s)
- M A Terenicheva
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia
| | - R M Shakhnovich
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia
| | - O V Stukalova
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia
| | - D V Pevzner
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia
| | - G K Arutyunyan
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia
| | - A Yu Demchenkova
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia
| | - I N Merkulova
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia
| | - S K Ternovoy
- National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, Moscow, Russia I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Stensjøen AL, Hommerstad A, Halvorsen S, Arheden H, Engblom H, Erlinge D, Larsen AI, Sejersten Ripa M, Clemmensen P, Atar D, Hall TS. Worst lead ST deviation and resolution of ST elevation at one hour for prediction of myocardial salvage, infarct size, and microvascular obstruction in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Ann Noninvasive Electrocardiol 2020; 25:e12784. [PMID: 32592427 PMCID: PMC7679835 DOI: 10.1111/anec.12784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 01/09/2023] Open
Abstract
Background ECG changes after revascularization predicts improved outcome for patients with ST‐elevation myocardial infarction (STEMI). Worst lead residual (WLR) ST deviation and resolution of worst lead ST elevation (rST elevation) are simple measures that can be obtained early after PCI. The objective of the current study was to investigate whether simple ECG measures, obtained one hour following PCI, could predict cardiac magnetic resonance (CMR)‐derived myocardial salvage index (MSI), infarct size (IS), and microvascular obstruction (MVO) in patients with STEMI included in the MITOCARE trial. Methods The MITOCARE trial included 165 patients with a first‐time STEMI presenting within six hours of symptom onset. The current analysis included patients that had an ECG recorded at baseline and one hour after PCI and underwent CMR imaging after 3–5 days. Independent core laboratories determined WLR ST deviation, rST elevation, and the CMR variables (MSI, IS, and MVO). Results 83 patients with a mean age of 61 years were included. 83.1% were males and 41% had anterior infarctions. In logistic regression models, WLR ST deviation was a statistically significant predictor of IS (OR 2.2, 95% CI 1.3–3.8) and MVO (OR 2.8, 95% CI 1.5–5.2), but not of MSI (OR 0.8, 95% CI 0.5–1.2). rST elevation showed a trend toward a significant association with IS (OR 0.3, 95% CI 0.1–1.0), but not with the other CMR variables. Conclusion WLR ST deviation one hour after PCI was a predictor of IS and MVO. WLR ST deviation, a measure easily obtained from ECGs following PCI, may provide important prognostic information in patients with STEMI.
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Affiliation(s)
| | - Anders Hommerstad
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Håkan Arheden
- Department of Clinical Sciences, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Sciences, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Alf-Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Maria Sejersten Ripa
- Novo Nordisk A/S, Søborg, Denmark.,Department of Cardiology, The Heart Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Peter Clemmensen
- Department of Cardiology, The Heart Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Department of Medicine, Division of Cardiology, Nykoebing-Falster Hospital, University of Southern Denmark, Odense, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of General and Intervention Cardiology, University Heart Center, Hamburg-Eppendorf, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Trygve S Hall
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
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