The central role of conventional 12-lead ECG for the assessment of microvascular obstruction after percutaneous myocardial revascularization

Fabio Infusino; Giampaolo Niccoli; Francesco Fracassi; Marco Roberto; Elena Falcioni; Gaetano A Lanza; Filippo Crea

doi:10.1016/j.jelectrocard.2013.10.002

The central role of conventional 12-lead ECG for the assessment of microvascular obstruction after percutaneous myocardial revascularization

J Electrocardiol. 2014 Jan-Feb;47(1):45-51. doi: 10.1016/j.jelectrocard.2013.10.002. Epub 2013 Oct 17.

Authors

Fabio Infusino¹, Giampaolo Niccoli², Francesco Fracassi¹, Marco Roberto¹, Elena Falcioni¹, Gaetano A Lanza¹, Filippo Crea¹

Affiliations

¹ Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
² Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: gniccoli73@hotmail.it.

PMID: 24290322
DOI: 10.1016/j.jelectrocard.2013.10.002

Abstract

Guidelines report that the optimal treatment for ST-elevation myocardial infarction (STEMI) is a primary percutaneous coronary intervention (PPCI) when performed timely by trained operators. Yet, the reopening of the infarct-related artery (IRA) is not always followed by myocardial reperfusion. This phenomenon is most commonly called "no-reflow", is caused by microvascular obstruction (MVO) and is associated to a worse outcome. Electrocardiogram (ECG) is crucial for the diagnosis of STEMI, but is also useful for the assessment of MVO. In this review we summarize ECG-derived parameters associated to MVO and their prognostic relevance.

Keywords: Acute myocardial infarction; CMR; ECG; Electrocardiogram; HRT; HRV; IRA; MBG; MCE; MVO; Microvascular obstruction; PPCI; PTCA; ST segment elevation; ST segment elevation myocardial infarction; ST segment elevation resolution; STE; STEMI; STER; STR; TIMI; Thrombolysis In Myocardial Infarction; cardiovascular magnetic resonance; electrocardiogram; heart rate turbulence; heart rate variability; infarct-related artery; microvascular obstruction; myocardial blush grade; myocardial contrast echocardiography; percutaneous transluminal coronary angioplasty; primary percutaneous coronary intervention; rate of ST segment elevation resolution.

Publication types

Review

MeSH terms

Coronary Stenosis / diagnosis*
Coronary Stenosis / etiology*
Electrocardiography / methods*
Humans
Myocardial Infarction / diagnosis*
Myocardial Infarction / etiology*
Percutaneous Coronary Intervention / adverse effects*
Reproducibility of Results
Sensitivity and Specificity
Treatment Outcome