CLINICAL RESEARCH: TREATMENT STANDARDS FOR ACUTE INFARCTION
Duration of Ischemia Is a Major Determinant of Transmurality and Severe Microvascular Obstruction After Primary Angioplasty
A Study Performed With Contrast-Enhanced Magnetic Resonance
Giuseppe Tarantini, MD, PhD*,
Luisa Cacciavillani, MD*,
Francesco Corbetti, MD ,*,
Angelo Ramondo, MD*,
Martina Perazzolo Marra, MD*,
Enrico Bacchiega, MD*,
Massimo Napodano, MD*,
Claudio Bilato, MD, PhD*,
Renato Razzolini, MD* and
Sabino Iliceto, MD, FACC*
* Department of Cardiac, Thoracic, and Vascular Sciences
Department of Radiology, University of Padova Medical School, Padua, Italy. A grant was received from Boehringer Ingelheim
Manuscript received September 23, 2004;
revised manuscript received May 25, 2005,
accepted June 7, 2005.
* Reprint requests and correspondence: Dr. Giuseppe Tarantini, Department of Cardiac, Thoracic, and Vascular Sciences, Policlinico Universitario, Via Giustiniani, 2, 35128 Padova, Italy
(Email: giuseppe.tarantini.1{at}unipd.it).
OBJECTIVES: This study sought to assess the relationship between duration of ischemia and both myocardial transmural necrosis (TN) and severe microvascular obstruction (SMO), by contrast-enhanced magnetic resonance (CE-MR), in patients with acute myocardial infarction (AMI) treated with angioplasty (PCI), and to estimate the risk of TN and SMO with the duration of ischemia.
BACKGROUND: The impact of ischemic time on myocardial and microvascular injury is not well characterized in people.
METHODS: We performed CE-MR in 77 patients with first AMI, 5 ± 3 days after successful PCI. The AMI was labeled as transmural if hyperenhancement at CE-MR was extended to  75% of the thickness in two or more ventricular segments. The SMO was identified as areas of late hypoenhancement surrounded by hyperenhanced tissue. The relationship between ischemic time and CE-MR evidence of SMO or TN was evaluated by logistic regression.
RESULTS: Thirteen patients were excluded because of preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 of the infarct-related artery. For the remaining 64 patients, the mean time to treatment was 190 ± 110 min, 45 (65%) patients had TN and 23 (39%) had SMO. Mean pain to balloon time was 90 ± 40 min, 110 ± 107 min, and 137 ± 97 min in patients without TN and SMO, with TN but without SMO, or with both TN and SMO, respectively (p = 0.001). Multivariate analysis showed that time delay was significantly associated both with TN (odds ratio per 30 min, 1.37, p = 0.032), and SMO (odds ratio per 30 min, 1.21; p = 0.021).
CONCLUSIONS: In AMI patients with impaired coronary perfusion undergoing PCI, the risk of TN and SMO increases with the duration of the ischemic time.
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Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | CE-MR = contrast-enhanced magnetic resonance | | MBG = myocardial blush grade | | PCI = percutaneous coronary intervention | | SMO = severe microvascular obstruction | | TIMI = Thrombolysis In Myocardial Infarction | | TN = transmural necrosis |
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