Role of percutaneous transluminal coronary angioplasty in patients of exercise induced ST segment elevation in infarct related leads.

In patients with recent myocardial infarction (MI), exercise induced ST segment elevation on infarct related leads is shown to be due to ischaemia within or around partially necrotic area. To study this hypothesis we studied 15 patients of recent MI who had ST segment elevation in infarct related leads. In 13 patients infarct related artery was patient with severe stenosis (85 +/- 8%) and in 2 patients infarct related artery was totally occluded. The patients with patent culprit artery were elected for percutaneous transluminal coronary angioplasty (PTCA). During balloon inflation 10 patients had ST segment elevation on some leads that showed ST elevation during exercise and 6 patients also had angina. There was no significant change in pulmonary artery pressure and systemic blood pressure during PTCA. Post PTCA stress test after 2 week showed decrease in ST elevation compared to previous stress tests. Therefore exercise induced ST segment elevation in infarct related leads is suggestive of ischaemia rather that left ventricular dysfunction. In such patients it may be considered as indication for revascularization.