Echocardiographic evaluation of post MI patients with consistent ST segment elevation who underwent angiography: a follow up study

Document Type : Original Article


1 Bentolhoda Panjalizadeh, MD Resident of Cardiology, Department of Cardiology, Faculty of Medicineof Medicine, Mashhad University of Medical Sciences, Mashhad, Iran( corresponding author). Email: Pa

2 Mohsen Mohebati, MD Cardiologist, associated professor of cardiology, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Email: MouhebatiM@mums.a


Introduction: Percutaneous intervention(PCI) is an accepted method of reperfusion in patients with acute ST-segment elevation myocardial infarction (STEMI). Establishing coronary blood flow during angiography does not always result in proper cardiac circulation. There are many factors related to patient outcomes after primary PCI. ST-segment resolution (STSR) is one of these factors that can be achieved noninvasively and indicates reperfusion. However, the relationship between STSR and echocardiographic findings is not widely studied. The aim of the present study is to evaluate electrocardiogram (ECG) and echocardiography findings in post-STEMI patients undergoing PCI. Materials and methods: A total of 340 patients who had STEMI and underwent successful PCI were chosen by convenience sampling and enrolled in this follow up study. After considering the exclusion criteria, 12-lead ECG was performed on each patient at 60min, 90min, 120min, 24 h and 2 months after PCI. Additionally,a transthoracic echocardiogram (TTE) was performed after PCI, and 2 additional TTEs were performed—one each at 24 hpost-PCI and 2 months after PCI. ST-segment resolution was evaluated in every ECG, and the results were compared with the TTE findings. Results: The mean±SD for the time duration between the onset of symptoms and calling EMS, the door-to-balloon time, and the time duration between the first medical staff visit andangioplasty were 114.4±56.63 min, 35.58±4.43 min and 60.58±4.43 min, respectively. Ejection fraction and end systolic volume in patients with ST-segment resolution greater than 30% at 60min, 90min, 120min and 24 h after PCI were significantly higher than that in patients with resolution lower than 30%. This finding was not observed 2 months after PCI. Conclusion: While delays in managing patients with STEMI had favorable outcomes in our center in contrast to similar studies, attempts should be made to reduce these delays. STSR greater than 30% at 90min and 120min after successful PCI in patients with STEMI is significantly related with higher ejection fractions and lower end-systolic volumes. However, if the STSR occurs after 24 hours, then these patients are more likely to have lower ejection fractionsand larger end-systolic volumes.


1. Roth GA, Forouzanfar MH, Moran AE, Barber 
R, Nguyen G, Feigin VL, et al. Demographic and 
epidemiologic drivers of global cardiovascular mortality. 
New England Journal of Medicine. 2015;372(14):1333-
2. Ahmadi A, Soori H, Mehrabi Y, Etemad K, Samavat T, 
Khaledifar A. Incidence of acute myocardial infarction in 
Islamic Republic of Iran: a study using national registry 
data in 2012. East Mediterr Health J. 2014.
3. Reed GW, Rossi JE, Cannon CP. Acute myocardial 
infarction. The Lancet.389(10065):197-210.
4. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, 
Chung MK, De Lemos JA, et al. 2013 ACCF/AHA 
guideline for the management of ST-elevation myocardial 
infarction. Circulation. 2013;127(4
5. Infusino F, Niccoli G, Fracassi F, Roberto M, Falcioni 
E, Lanza GA, et al. The central role of conventional 12-
lead ECG for the assessment of microvascular obstruction 
after percutaneous myocardial revascularization. Journal 
of electrocardiology. 2014;47(1):45-51.
6. Shah A, Wagner GS, Granger CB, O’Connor CM, 
Green CL, Trollinger KM, et al. Prognostic implications 
of TIMI flow grade in the infarct related artery compared 
with continuous 12-lead ST-segment resolution analysis: 
Reexamining the “gold standard” for myocardial 
reperfusion assessment. Journal of the American College 
of Cardiology. 2000;35(3):666-72.
7. Ito H, Maruyama A, Iwakura K, Takiuchi S, Masuyama 
T, Hori M, et al. Clinical implications of the ‘no 
reflow’phenomenon. Circulation. 1996;93(2):223-8.
8. Claeys MJ, Bosmans J, Veenstra L, Jorens P, De Raedt 
H, Vrints CJ. Determinants and prognostic implications 
of persistent ST-segment elevation after primary 
angioplasty for acute myocardial infarction. Circulation. 
9. de Lemos JA, Braunwald E. ST segment resolution 
as a tool for assessing the efficacy of reperfusion 
therapy. Journal of the American College of Cardiology. 
10. Hallén J, Sejersten M,Johanson P,Atar D,Clemmensen 
PM. Influence of ST-Segment Recovery on Infarct Size 
and Ejection Fraction in Patients With ST-Segment 
Elevation Myocardial Infarction Receiving Primary 
Percutaneous Coronary Intervention. The American 
Journal of Cardiology. 2010;105(9):1223-8.
11. Thiele H, Eitel I, Meinberg C, Desch S, Leuschner 
A, Pfeiffer D, et al. Randomized Comparison of PreHospital–Initiated Facilitated Percutaneous Coronary
Intervention Versus Primary Percutaneous Coronary 
Intervention in Acute Myocardial Infarction Very Early 
After Symptom Onset: The LIPSIA-STEMI Trial (Leipzig 
Immediate Prehospital Facilitated Angioplasty in STSegment Myocardial Infarction). JACC: Cardiovascular 
Interventions. 2011;4(6):605-14.
12. Kassaian SE, Masoudkabir F, Sezavar H, Mohammadi 
M, Pourmoghaddas A, Kojouri J, et al. Clinical 
characteristics, management and 1-year outcomes of 
patients with acute coronary syndrome in Iran: the Iranian 
Project for Assessment of Coronary Events 2 (IPACE2). 
BMJ open. 2015;5(12):e007786.
13. Farag EM, Al-Daydamony MM. Symptom-toballoon time and myocardial blush grade are predictors 
of left ventricular remodelling after successful primary 
percutaneous coronary intervention. Cardiovascular 
journal of Africa. 2016;27:1-5.
14. Lenz CJ, Abdelmoneim SS, Anavekar NS, Foley TA, 
Nhola LF, Huang R, et al. A comparison of infarct mass 
by cardiac magnetic resonance and real-time myocardial 
perfusion echocardiography as predictors of major adverse 
cardiac events following reperfusion for ST-elevation 
myocardial infarction. Echocardiography (Mount Kisco, 
NY). 2016;33(10):1539-45.
15. Farkouh ME, Reiffel J, Dressler O, Nikolsky E, Parise 
H, Cristea E, et al. Relationship between ST-segment 
recovery and clinical outcomes after primary percutaneous 
coronary intervention: the HORIZONS-AMI ECG 
substudy report. Circulation Cardiovascular interventions. 
16. Sanati HR, Mahjoob MP, Zahedmehr A, Ghahferokhi 
FS, Firoozi A, Kiani R, et al. Risk Factors of Reperfusion 
Failure following Primary Angioplasty for ST-Segment 
Elevation Myocardial Infarction (STEMI). The Journal of 
Tehran University Heart Center. 2013;8(3):146-51.
17. Nijveldt R, van der Vleuten PA, Hirsch A, Beek AM, 
Tio RA, Tijssen JGP, et al. Early Electrocardiographic 
Findings, and MR Imaging-Verified Microvascular Injury 
and Myocardial Infarct Size. JACC: Cardiovascular 
Imaging. 2009;2(10):1187-94.
18. 30. Somitsu Y,Nakamura M, Degawa T,Yamaguchi
T. Prognostic value of slow resolution of ST-segment 
elevation following successful direct percutaneous 
transluminal coronary angioplasty for recovery of left 
ventricular function. The American journal of cardiology. 
19. Kim J-S, Ko Y-G, Yoon S-J, Moon J-Y, Kim YJ, 
Choi BW, et al. Correlation of serial cardiac magnetic 
resonance imaging parameters with early resolution of STsegment elevation after primary percutaneous coronary 
intervention. Circulation Journal. 2008;72(10):1621-6