Objective: To study the relation between resolution of ST segment devia tion an d infarct size using positron emission tomography. Methods: 45 patients with ST segment elevation acute myocardial infarction treated with thrombolysis or percu taneous coronary intervention were studied prospectively. An ECG was taken befor e and at (mean (SD)) 100 (45) min after reperfusion therapy. ECGs were analysed by three methods. Residual ST segment deviation, obtained from the ECG immediate ly after completion of reperfusion therapy, was defined by summation for each of the three methods. Relative resolution of ST segment deviation was defined as t he absolute resolution divided by the ST segment deviation score at baseline x 1 00(%). After 29 (14) hours, myocardial blood flow was measured with 13NH3. For each patient, the regions with a myocardial blood flow < 80%of normally perfuse d myocardium (=hypoperfusion) and < 50%(=no reflow) were automatically delineat ed. Results: Substantial differences were found between different ECG analysis m ethods. There were moderate correlations between the area with myocardial hypope rfusion and ST segment deviation scores at baseline and after reperfusion therap y. After reperfusion therapy, residual ST segment deviation in the single lead w ith maximum ST segment deviation was as good at discriminating between fertiles of myocardial damage as summed ST segment elevation. Relative ST segment resolut ion did not discriminate between different degrees of myocardial damage. Conclus ions: In the individual patient, residual ST segment deviation after reperfusion in the single lead with maximum ST segment deviation is at least as good as sum med ST elevation in predicting final myocardial damage.
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