Functional and structural correlates of persistent ST elevation after acute myocardial infarction successfully treated by percutaneous coronary intervention

Background: In the thrombolytic era, persistence of ST-segment elevation was considered a marker of LV aneurysm. ST-segment elevation may still be found persistently elevated after successful primary PCI. Echocardiographic correlates of this finding, however, are still poorly known. Methods and Results: Eighty-two consecutive patients with first STEMI and successful PCI were divided in patients with persistent ST- segment elevation at discharge (sum of ST > 4 mm) (n=33) and without persistent ST- segment elevation (n=49). Conventional and myocardial contrast echocardiography (MCE) were performed at discharge and at 6 months. At discharge, LV aneurysm was more frequent in persistent ST-elevation patients (30%, p<0.005). Similarly, WMSI was higher (p<0.005) and microvascular damage larger (p<0.005) in patients with persistent ST-segment elevation. At 6 months follow-up, LV volumes were similar in the two groups. Conclusions: After primary PCI, persistent ST-segment elevation is associated with LV aneurysm formation in 30% of cases, it is not associated with significantly larger LV dilation but with larger microvascular damage and dysfunctioning risk area