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J Am Coll Cardiol, 2005; 46:1229-1235, doi:10.1016/j.jacc.2005.06.054 (Published online 9 September 2005).
© 2005 by the American College of Cardiology Foundation
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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{dagger},*, 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
{dagger} 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.

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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