- Poster presentation
- Open Access
Reciprocal ECG change in ST-elevation myocardial infarction is associated with area at risk and myocardial salvage following revascularization
© Kidambi et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- Infarct Size
- Primary Percutaneous Coronary Intervention
- Myocardial Salvage
- Remote Myocardium
- British Heart Foundation
ST elevation acute myocardial infarction (STEMI) is frequently associated with reciprocal ST depression in the contralateral ECG leads. The ECG remains a primary diagnostic factor in the hyperacute treatment of AMI. There has been longstanding debate over the relevance of reciprocal ECG changes in AMI.
CMR can retrospectively determine myocardial area at risk (AAR), namely, the area of myocardium that is susceptible to infarction prior to opening the infarct-related artery. T2-weighted (T2w) imaging can be combined with measures of infarction by late gadolinium enhanced (LGE) imaging to derive myocardial salvage, a measure with established prognostic relevance. We hypothesised that reciprocal ECG change reflects larger AAR as defined by CMR.
No reciprocal ECG change (n=16)
Reciprocal ECG change (n=19)
58 ± 3
57 ± 2
5.9 ± 0.2
5.6 ± 0.5
Pain onset to <br/> revascularization time (min)
237 ± 35
230 ± 29
TIMI 3 at end of procedure
Body surface area
2.0 ± 0.03
2.0 ± 0.04
Patients with STEMI presenting with reciprocal ECG changes have significantly larger AAR, and significantly higher myocardial salvage and salvage index than those without. Reciprocal ECG changes may be a marker of larger volumes of myocardium at risk, and may also denote patients with larger potential for salvage with revascularization. There was no relationship to infarct size, presumably as other factors, such as time to revascularization and TIMI flow post-procedure will influence the degree of myocardium infarcted.
S.P is funded by British Heart Foundation fellowship (FS/10/62/28409)
S.P and J.P.G receive a research grant from Philips Healthcare
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.