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Title: Factors associated with longer delays in reperfusion in ST-segment elevation myocardial infarction

Authors:
; ;
Publication Date:
Sponsoring Org.:
USDOE Office of Nuclear Energy (NE), Fuel Cycle Technologies (NE-5)
OSTI Identifier:
1438498
Grant/Contract Number:
PEst-OE/MAT/UI0006/2011
Resource Type:
Journal Article: Published Article
Journal Name:
IJC Heart & Vessels
Additional Journal Information:
Journal Volume: 4; Journal Issue: C; Related Information: CHORUS Timestamp: 2018-05-23 05:30:30; Journal ID: ISSN 2214-7632
Publisher:
Elsevier
Country of Publication:
Country unknown/Code not available
Language:
English

Citation Formats

Abreu, Daisy, Salomé Cabral, M., and Ribeiro, Fernando. Factors associated with longer delays in reperfusion in ST-segment elevation myocardial infarction. Country unknown/Code not available: N. p., 2014. Web. doi:10.1016/j.ijchv.2014.06.007.
Abreu, Daisy, Salomé Cabral, M., & Ribeiro, Fernando. Factors associated with longer delays in reperfusion in ST-segment elevation myocardial infarction. Country unknown/Code not available. doi:10.1016/j.ijchv.2014.06.007.
Abreu, Daisy, Salomé Cabral, M., and Ribeiro, Fernando. Mon . "Factors associated with longer delays in reperfusion in ST-segment elevation myocardial infarction". Country unknown/Code not available. doi:10.1016/j.ijchv.2014.06.007.
@article{osti_1438498,
title = {Factors associated with longer delays in reperfusion in ST-segment elevation myocardial infarction},
author = {Abreu, Daisy and Salomé Cabral, M. and Ribeiro, Fernando},
abstractNote = {},
doi = {10.1016/j.ijchv.2014.06.007},
journal = {IJC Heart & Vessels},
number = C,
volume = 4,
place = {Country unknown/Code not available},
year = {Mon Sep 01 00:00:00 EDT 2014},
month = {Mon Sep 01 00:00:00 EDT 2014}
}

Journal Article:
Free Publicly Available Full Text
Publisher's Version of Record at 10.1016/j.ijchv.2014.06.007

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  • To investigate the myocardial perfusion correlates of precordial ST segment depression during acute inferior myocardial infarction, a rest thallium-201 scintigram and a closely timed 12 lead electrocardiogram were obtained within 6 hours of the onset of infarction in 44 patients admitted with their first acute inferior myocardial infarction. Thirty-six patients demonstrated precordial ST segment depression (group 1) and eight did not (group 2). A perfusion defect involving the inferior wall was present in all 44 patients. Additional perfusion defects of the adjacent posterolateral wall (n . 20), the ventricular septum (n . 9) or both (n . 6) were presentmore » in 35 of 36 patients from group 1 compared with only 1 of 8 patients from group 2 (p less than 0.001). There was no significant difference in the frequency of multivessel coronary artery disease or disease of the left anterior descending artery between group 1 and group 2 or between patients with and those without a thallium-201 perfusion defect involving the ventricular septum. Thus, precordial ST segment depression during an acute inferior myocardial infarction is associated with thallium-201 scintigraphic evidence of more extensive involvement of the adjacent posterolateral or inferoseptal myocardial segments, which probably reflects the extent and pattern of distribution of the artery of infarction, rather than the presence of coexistent multivessel coronary artery disease or disease of the left anterior descending artery.« less
  • The clinical significance of anterior precordial ST segment depression during acute inferior myocardial infarction was evaluated in 67 consecutive patients early after onset of symptoms with gated blood pool scans, thallium-201 perfusion images, and 12-lead ECGs. Patients with anterior ST depression (n = 33) had depressed mean values for left ventricular ejection fraction (54 +/- 2% (mean +/- S.E.M.) vs 59 +/- 2%; p = 0.02), cardiac index (3.1 +/- 0.2 vs 3.6 +/- 0.2 L/m2; p = 0.03), and ratio of systolic blood pressure to end-systolic volume (2.0 +/- 0.1 vs 2.5 +/- 0.3 mm Hg/ml; p = 0.04)more » compared to patients with no anterior ST depression (n = 34). Patients with anterior ST depression had (1) lower mean wall motion values for the inferior, apical, and inferior posterolateral segments (p less than 0.05) and (2) greater reductions in thallium-201 uptake in the inferior and posterolateral regions (p less than 0.05). However, anterior and septal (1) wall motion and (2) thallium-201 uptake were similar in patients with and without ST depression. Thus, anterior precordial ST segment depression in patients with acute inferior wall myocardial infarction represents more than a reciprocal electrical phenomenon. It identifies patients with more severe wall motion impairment and greater hypoperfusion of the inferior and adjacent segments. The poorer global left ventricular function in these patients is a result of more extensive inferior infarction and not of remote septal or anterior injury.« less
  • In a randomized trial of intracoronary streptokinase (STK) therapy in acute myocardial infarction, 44 patients (21 control subjects and 23 patients treated with STK) underwent sequential thallium-201 planar imaging before angiography and after 4 hours (redistribution), 4 days and 6 weeks. Patients were classified according to the presence or absence of angiographic reperfusion of the infarct-related artery. The semiquantitative score of myocardial thallium uptake was expressed as percent of maximal defect score. Both in control and in STK-treated groups, thallium defect scores decreased over time, but this decrease was smaller in the control group (before angiography, 33 +/- 4%; redistribution,more » 29 +/- 4%; 4 days, 25 +/- 4%; and 6 weeks, 22 +/- 4%) than in the STK group (44 +/- 4%, 38 +/- 4%, 26 +/- 4% and 21 +/- 3%, respectively). In patients in whom reperfusion was achieved (20 STK- treated, 6 control subjects), a marked decrease in thallium score was observed (before angiography, 40 +/- 4%; redistribution, 32 +/- 4%; 4 days, 20 +/- 5%; and 6 weeks, 14 +/- 22%) compared with patients in whom reperfusion was not achieved (37 +/- 4%, 36 +/- 5%, 33 +/- 5% and 33 +/- 4%, respectively). These results indicate that serial thallium imaging is an accurate method of assessing changes in myocardial perfusion after acute myocardial infarction. Restoration of thallium uptake was observed after reperfusion of the infarct-related artery whether this recanalization was seen spontaneously or after successful thrombolysis.« less
  • The value of technetium-99m pyrophosphate (Tc-99m-PYP) scintigraphy as an indicator of reperfusion 2.8 to 8 hours after the onset of symptoms of acute myocardial infarction was compared with the value of early peak creatine kinase (CK) and CK-MB release within 16 hours after the onset of symptoms. In 29 patients who received thrombolytic therapy, recanalization was seen (group 1) and in 7 it was not (group 2). In 23 patients (79%) in group 1 scintigraphic findings were positive and in all 7 in group 2 they were negative. In 15 patients (52%) in group 1 and 1 patient (14%) inmore » group 2, CK reached its peak level within 16 hours. In 20 patients (69%) in group 1 and 3 (43%) in group 2 the CK-MB level reached a peak within 16 hours. The sensitivity, specificity and predictive accuracy of positive results of early Tc-99m-PYP scintigraphy in predicting the reperfusion were 79%, 100% and 83%. These values are significantly higher than or similar to those of early peaking of CK and CK-MB release. In contrast to measurements of enzyme release, reperfusion data for Tc-99m-PYP scintigraphy are available immediately after thrombolytic therapy. Therefore, early Tc-99m-PYP scintigraphy (3 to 8 hours after onset of symptoms) is valuable as a noninvasive technique for early diagnosis of reperfusion.« less
  • We prospectively evaluated 241 consecutive patients with creatine kinase (MB fraction)-confirmed acute myocardial infarction with predischarge quantitative thallium-201 scintigraphy, coronary angiography, radionuclide ventriculography, and 24 hr Holter monitoring. Based on serial electrocardiograms, 154 patients had Q wave (QMI) and 87 had non-Q wave (NQMI) infarction. Despite less myocardial necrosis and better left ventricular function, the NQMI group had the same long-term survival as the QMI group. During 27 months of follow-up, patients with NQMI experienced more reinfarctions (p = .009), had a higher rate of unstable angina pectoris requiring rehospitalization (p = .034), and had a greater likelihood of subsequentmore » bypass surgery or angioplasty (p = .018). Based on our thallium scintigraphic data, the greater clinical instability after NQMI appeared to be related to the presence of a larger residual mass of viable but jeopardized myocardium within the perfusion zone of the infarct-related vessel. Our results also indicate that the pathogenesis of NQMI may involve early spontaneous reperfusion and that patients with NQMI can experience sudden death despite well-preserved left ventricular function.« less