ST elevation after myocardial infarction: what does it mean?

摘要

Acute coronary syndromes are currently classified according to the presence or absence of ST elevation at hospital admission. ST elevation usually reflects acute thrombotic coronary occlusion. The most effective treatment consists in recanalisation of the occluded artery as soon as possible, preferably by primary percutaneous coronary intervention (PCI) or by thrombo-lytic treatment. However, myocardial salvage relies on rapid, and sustained myocardial tissue perfu-sion. Epicardial patency does not necessarily imply adequate perfusion at the myocyte level. Alteration of endothelial integrity, tissue oedema, platelet aggregation, neutrophil infiltration, distal emboli sation of thrombus can compromise the restoration of myocardial perfusion. This low-reflow or no-reflow phenomenon related to microvascular damage can be demonstrated by several imaging modalities. It was first observed 15 years ago by intracoronary contrast echocardiography.