CLINICAL STUDY: ACUTE CORONARY SYNDROME/MYOCARDIAL INFARCTION
Thrombolysis in myocardial infarction myocardial perfusion grade in angiography correlates with myocardial salvage in patients with acute myocardial infarction treated with stenting or thrombolysis
Alban Dibra, MD*,
Julinda Mehilli, MD*,
Josef Dirschinger, MD*,
J.ürgen Pache, MD*,
Jodi Neverve, BS ,
Markus Schwaiger, MD,
Albert Schömig, MD* and
Adnan Kastrati, MD*,*
* Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Munich, Germany
Klinik und Poliklinik für Nuklearmedizin rechts der Isar, Technische Universität München, Munich, Germany
Manuscript received July 11, 2002;
revised manuscript received November 21, 2002,
accepted November 27, 2002.
* Reprint requests and correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum München, Lazarettstr. 36, 80636 Munich, Germany.
kastrati{at}dhm.mhn.de
OBJECTIVES: We sought to assess the relationship between the Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion (TMP) grade and myocardial salvage as well as the usefulness of TMP grade in comparing two different reperfusion strategies.
BACKGROUND: The angiographic index of TMP grade correlates with infarct size and mortality after thrombolysis for acute myocardial infarction (AMI). Its relationship to myocardial salvage and its usefulness in comparing different reperfusion strategies are not known.
METHODS: We analyzed the TMP grade on angiograms obtained at one to two weeks after treatment in 267 patients enrolled in two randomized trials that compared stenting with thrombolysis in AMI. Patients were classified into two groups: 159 patients with TMP grade 2/3 and 108 patients with TMP grade 0/1. Two scintigraphic studies were performed: before and one to two weeks after reperfusion. The salvage index was calculated as the proportion of the area at risk salvaged by reperfusion.
RESULTS: Patients with TMP grade 2/3 had a higher salvage index (0.49 ± 0.42 vs. 0.34 ± 0.49, p = 0.01), a smaller final infarct size (15.4 ± 15.5% vs. 22.1 ± 16.2% of the left ventricle, p = 0.001), and a trend toward lower one-year mortality (3.8% vs. 8.3%, p = 0.11) than patients with TMP grade 0/1. The relationship between TMP and salvage index was independent of the form of reperfusion therapy. The proportion of patients with TMP grade 2/3 was significantly higher after stenting than after thrombolysis (70.9% vs. 48.1%, p = 0.001).
CONCLUSIONS: These findings show that the TMP grade is a useful marker of the degree of myocardial salvage achieved with reperfusion and a sensitive indicator of the efficacy of reperfusion strategies in patients with AMI.
|
Abbreviations and Acronyms
| | AMI | | acute myocardial infarction | | IRA | | infarct-related artery | | LV | | left ventricle, left ventricular | | STOPAMI | | Stent versus Thrombolysis for Occluded coronary arteries in Patients with Acute Myocardial Infarction trial | | TIMI | | Thrombolysis In Myocardial Infarction | | TMP | | TIMI myocardial perfusion |
|
This article has been cited by other articles:
|
|
|
|
 
C. M. Gibson, Y. B. Pride, J. L. Buros, E. Lord, A. Shui, S. A. Murphy, D. S. Pinto, P. J. Zimetbaum, M. S. Sabatine, C. P. Cannon, et al.
Association of impaired thrombolysis in myocardial infarction myocardial perfusion grade with ventricular tachycardia and ventricular fibrillation following fibrinolytic therapy for ST-segment elevation myocardial infarction.
J. Am. Coll. Cardiol.,
February 5, 2008;
51(5):
546 - 551.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Ndrepepa, A. Kastrati, J. Mehilli, F.-J. Neumann, J. ten Berg, O. Bruskina, F. Dotzer, M. Seyfarth, J. Pache, J. Dirschinger, et al.
Age-Dependent Effect of Abciximab in Patients With Acute Coronary Syndromes Treated With Percutaneous Coronary Interventions
Circulation,
November 7, 2006;
114(19):
2040 - 2046.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. J. Gibson and C. M. Gibson
The association of impaired myocardial perfusion and monocytosis with late recovery of left ventricular function following primary percutaneous coronary intervention
Eur. Heart J.,
November 1, 2006;
27(21):
2487 - 2488.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Kirtane, J. J. Vafai, S. A. Murphy, J. M. Aroesty, M. S. Sabatine, C. P. Cannon, C. M. Gibson, and for the TIMI Study Group
Angiographically evident thrombus following fibrinolytic therapy is associated with impaired myocardial perfusion in STEMI: a CLARITY-TIMI 28 substudy
Eur. Heart J.,
September 1, 2006;
27(17):
2040 - 2045.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-P. Collet and G. Montalescot
The acute reperfusion management of STEMI in patients with impaired glucose tolerance and type 2 diabetes
Diabetes and Vascular Disease Research,
October 1, 2005;
2(3):
136 - 143.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. M. Gibson, S. A. Murphy, A. J. Kirtane, R. P. Giugliano, C. P. Cannon, E. M. Antman, E. Braunwald, and TIMI Study Group
Association of duration of symptoms at presentation with angiographic and clinical outcomes after fibrinolytic therapy in patients with st-segment elevation myocardial infarction
J. Am. Coll. Cardiol.,
September 1, 2004;
44(5):
980 - 987.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Gibson and A. Schomig
Coronary and Myocardial Angiography: Angiographic Assessment of Both Epicardial and Myocardial Perfusion
Circulation,
June 29, 2004;
109(25):
3096 - 3105.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Ndrepepa, J. Mehilli, M. Schwaiger, H. Schuhlen, S. Nekolla, S. Martinoff, C. Schmitt, J. Dirschinger, A. Schomig, and A. Kastrati
Prognostic Value of Myocardial Salvage Achieved by Reperfusion Therapy in Patients with Acute Myocardial Infarction
J. Nucl. Med.,
May 1, 2004;
45(5):
725 - 729.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
