CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Impact of Primary Coronary Angioplasty Delay on Myocardial Salvage, Infarct Size, and Microvascular Damage in Patients With ST-Segment Elevation Myocardial InfarctionInsight From Cardiovascular Magnetic Resonance
Marco Francone, MD, PhD, MSc*,
Chiara Bucciarelli-Ducci, MD , ,
Iacopo Carbone, MD*,
Emanuele Canali, MD ,
Raffaele Scardala, MD ,
Francesca A. Calabrese, MD*,
Gennaro Sardella, MD ,
Massimo Mancone, MD ,
Carlo Catalano, MD*,
Francesco Fedele, MD ,
Roberto Passariello, MD*,
Jan Bogaert, MD, PhD|| and
Luciano Agati, MD ,*
* Cardiovascular Magnetic Resonance Unit, Department of Radiology Sciences, "Sapienza" University of Rome, Rome, Italy
Cardiac Imaging Unit and Cardiovascular Division, "Sapienza" University of Rome, Rome, Italy
Catheterization Laboratory, Department of Cardiology Sciences, "Sapienza" University of Rome, Rome, Italy
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
|| Department of Medical Imaging, Gasthuisberg University Hospital, Leuven, Belgium
Manuscript received May 3, 2009;
revised manuscript received August 13, 2009,
accepted August 30, 2009.
* Reprint requests and correspondence: Dr. Luciano Agati, Professor of Cardiology, Head of Cardiac Imaging Unit, Department of Cardiology, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Roma, Italy (Email: luciano.agati{at}uniroma1.it).
Objectives: We investigated the extent and nature of myocardial damage by using cardiovascular magnetic resonance (CMR) in relation to different time-to-reperfusion intervals.
Background: Previous studies evaluating the influence of time to reperfusion on infarct size (IS) and myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) have yielded conflicting results.
Methods: Seventy patients with STEMI successfully treated with primary percutaneous coronary intervention within 12 h from symptom onset underwent CMR 3 ± 2 days after hospital admission. Patients were subcategorized into 4 time-to-reperfusion (symptom onset to balloon) quartiles: 90 min (group I, n = 19), >90 to 150 min (group II, n = 17), >150 to 360 min (group III, n = 17), and >360 min (group IV, n = 17). T2-weighted short tau inversion recovery and late gadolinium enhancement CMR were used to characterize reversible and irreversible myocardial injury (area at risk and IS, respectively); salvaged myocardium was defined as the normalized difference between extent of T2-weighted short tau inversion recovery and late gadolinium enhancement.
Results: Shorter time-to-reperfusion (group I) was associated with smaller IS and microvascular obstruction and larger salvaged myocardium. Mean IS progressively increased overtime: 8% (group I), 11.7% (group II), 12.7% (group III), and 17.9% (group IV), p = 0.017; similarly, MVO was larger in patients reperfused later (0.5%, 1.5%, 3.7%, and 6.6%, respectively, p = 0.047). Accordingly, salvaged myocardium markedly decreased when reperfusion occurred >90 min of coronary occlusion (8.5%, 3.2%, 2.4%, and 2.1%, respectively, p = 0.004).
Conclusions: In patients with STEMI treated with primary percutaneous coronary intervention, time to reperfusion determines the extent of reversible and irreversible myocardial injury assessed by CMR. In particular, salvaged myocardium is markedly reduced when reperfusion occurs >90 min of coronary occlusion.
Key Words: myocardial salvage myocardial infarction microvascular injury cardiovascular magnetic resonance time to reperfusion
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Abbreviations and Acronyms
| | CMR = cardiovascular magnetic resonance | | IRA = infarct-related artery | | IS = infarct size | | LAD = left anterior descending artery | | LGE = late gadolinium enhancement | | LV = left ventricle/ventricular | | LVEDV = left ventricular end-diastolic volume | | LVEF = left ventricular ejection fraction | | LVESV = left ventricular end-systolic volume | | MVO = microvascular obstruction | | PCI = percutaneous coronary intervention | | PPCI = primary percutaneous coronary intervention | | SSFP = steady-state free precession | | STEMI = ST-segment elevation myocardial infarction | | T2w-STIR = T2-weighted short tau inversion recovery | | TE = echo time | | TR = repetition time |
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