Advertisement

Click here for more guidelines.

 
 




CME Topic Collections Past Issues Search Current Issue Home
     

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
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
j.jacc.2005.06.054v1
46/7/1229    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tarantini, G.
Right arrow Articles by Iliceto, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tarantini, G.
Right arrow Articles by Iliceto, S.

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




This article has been cited by other articles:


Home page
J Am Coll Cardiol IntvHome page
A. E. Denktas, H. V. Anderson, J. McCarthy, and R. W. Smalling
Total Ischemic Time: The Correct Focus of Attention for Optimal ST-Segment Elevation Myocardial Infarction Care
J. Am. Coll. Cardiol. Intv., June 1, 2011; 4(6): 599 - 604.
[Abstract] [Full Text] [PDF]


Home page
Circ Arrhythm ElectrophysiolHome page
S. R. D. Piers, A. P. Wijnmaalen, C. J. W. Borleffs, C. F. B. van Huls van Taxis, J. Thijssen, J. B. van Rees, S. C. Cannegieter, J. J. Bax, M. J. Schalij, and K. Zeppenfeld
Early Reperfusion Therapy Affects Inducibility, Cycle Length, and Occurrence of Ventricular Tachycardia Late After Myocardial Infarction
Circ Arrhythm Electrophysiol, April 1, 2011; 4(2): 195 - 201.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
M. Perazzolo Marra, J. A. C. Lima, and S. Iliceto
MRI in acute myocardial infarction
Eur. Heart J., February 1, 2011; 32(3): 284 - 293.
[Abstract] [Full Text] [PDF]


Home page
Circ Cardiovasc IntervHome page
T. K. Steigen, C. E. Buller, G. B. John Mancini, V. Jorapur, W. J. Cantor, J. M. Rankin, B. Thomas, J. G. Webb, S. S. Kronsberg, D. J. Atchison, et al.
Myocardial Perfusion Grade After Late Infarct Artery Recanalization Is Associated With Global and Regional Left Ventricular Function at One Year: Analysis From the Total Occlusion Study of Canada-2
Circ Cardiovasc Interv, December 1, 2010; 3(6): 549 - 555.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
K. Huber, D. R. Holmes Jr, A. W. van 't Hof, G. Montalescot, P. E. Aylward, G. A. Betriu, P. Widimsky, C. M. Westerhout, C. B. Granger, and P. W. Armstrong
Use of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention: insights from the APEX-AMI trial
Eur. Heart J., July 2, 2010; 31(14): 1708 - 1716.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
W. G. Hundley, D. A. Bluemke, J. P. Finn, S. D. Flamm, M. A. Fogel, M. G. Friedrich, V. B. Ho, M. Jerosch-Herold, C. M. Kramer, W. J. Manning, et al.
ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
J. Am. Coll. Cardiol., June 8, 2010; 55(23): 2614 - 2662.
[Full Text] [PDF]


Home page
CirculationHome page
WRITING COMMITTEE MEMBERS, W. G. Hundley, D. A. Bluemke, J. P. Finn, S. D. Flamm, M. A. Fogel, M. G. Friedrich, V. B. Ho, M. Jerosch-Herold, C. M. Kramer, et al.
ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents
Circulation, June 8, 2010; 121(22): 2462 - 2508.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
H. Thiele, L. Hildebrand, C. Schirdewahn, I. Eitel, V. Adams, G. Fuernau, S. Erbs, A. Linke, K. W. Diederich, M. Nowak, et al.
Impact of High-Dose N-Acetylcysteine Versus Placebo on Contrast-Induced Nephropathy and Myocardial Reperfusion Injury in Unselected Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The LIPSIA-N-ACC (Prospective, Single-Blind, Placebo-Controlled, Randomized Leipzig Immediate PercutaneouS Coronary Intervention Acute Myocardial Infarction N-ACC) Trial
J. Am. Coll. Cardiol., May 18, 2010; 55(20): 2201 - 2209.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll Cardiol ImgHome page
J. T. Ortiz-Perez, D. C. Lee, S. N. Meyers, C. J. Davidson, R. O. Bonow, and E. Wu
Determinants of Myocardial Salvage During Acute Myocardial Infarction: Evaluation With a Combined Angiographic and CMR Myocardial Salvage Index
J. Am. Coll. Cardiol. Img., May 1, 2010; 3(5): 491 - 500.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
G. Tarantini, R. Razzolini, M. Napodano, C. Bilato, A. Ramondo, and S. Iliceto
Acceptable reperfusion delay to prefer primary angioplasty over fibrin-specific thrombolytic therapy is affected (mainly) by the patient's mortality risk: 1 h does not fit all
Eur. Heart J., March 2, 2010; 31(6): 676 - 683.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
C. Hagl, N. Khaladj, S. Peterss, A. Martens, I. Kutschka, H. Goerler, M. Shrestha, and A. Haverich
Acute Treatment of ST-Segment-Elevation Myocardial Infarction: Is There a Role for the Cardiac Surgeon?
Ann. Thorac. Surg., December 1, 2009; 88(6): 1786 - 1792.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
M. Francone, C. Bucciarelli-Ducci, I. Carbone, E. Canali, R. Scardala, F. A. Calabrese, G. Sardella, M. Mancone, C. Catalano, F. Fedele, et al.
Impact of Primary Coronary Angioplasty Delay on Myocardial Salvage, Infarct Size, and Microvascular Damage in Patients With ST-Segment Elevation Myocardial Infarction: Insight From Cardiovascular Magnetic Resonance
J. Am. Coll. Cardiol., December 1, 2009; 54(23): 2145 - 2153.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Roentgenol.Home page
Y. Mikami, H. Sakuma, M. Nagata, M. Ishida, T. Kurita, I. Komuro, and M. Ito
Relation Between Signal Intensity on T2-Weighted MR Images and Presence of Microvascular Obstruction in Patients With Acute Myocardial Infarction
Am. J. Roentgenol., October 1, 2009; 193(4): W321 - W326.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
D. P. O'Regan, R. Ahmed, C. Neuwirth, Y. Tan, G. Durighel, J. V. Hajnal, I. Nadra, S. J. Corbett, and S. A. Cook
Cardiac MRI of myocardial salvage at the peri-infarct border zones after primary coronary intervention
Am J Physiol Heart Circ Physiol, July 1, 2009; 297(1): H340 - H346.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
M. Napodano, A. Ramondo, G. Tarantini, D. Peluso, S. Compagno, C. Fraccaro, A. C. Frigo, R. Razzolini, and S. Iliceto
Predictors and time-related impact of distal embolization during primary angioplasty
Eur. Heart J., February 1, 2009; 30(3): 305 - 313.
[Abstract] [Full Text] [PDF]


Home page
HeartHome page
G De Luca, C M Gibson, F Bellandi, S Murphy, M Maioli, M Noc, U Zeymer, D Dudek, H-R Arntz, S Zorman, et al.
Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis
Heart, December 1, 2008; 94(12): 1548 - 1558.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart J SupplHome page
G. De Luca
Adjunctive antithrombotic therapy during primary percutaneous coronary intervention
Eur. Heart J. Suppl., December 1, 2008; 10(suppl_J): J2 - J14.
[Abstract] [Full Text] [PDF]


Home page
HeartHome page
J. F Younger, S. Plein, J. Barth, J. P Ridgway, S. G Ball, and J. P Greenwood
Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction
Heart, December 1, 2007; 93(12): 1547 - 1551.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
C. B. Granger and M. R. Patel
The Search for Myocardial Protection: Is There Still Hope?
J. Am. Coll. Cardiol., July 31, 2007; 50(5): 406 - 408.
[Full Text] [PDF]


Home page
Eur Heart JHome page
H. Thiele, M. J. Kappl, A. Linke, S. Erbs, E. Boudriot, A. Lembcke, D. Kivelitz, and G. Schuler
Influence of time-to-treatment, TIMI-flow grades, and ST-segment resolution on infarct size and infarct transmurality as assessed by delayed enhancement magnetic resonance imaging
Eur. Heart J., June 6, 2007; (2007) ehm173v1.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
A. Lerman, D. R. Holmes, J. Herrmann, and B. J. Gersh
Microcirculatory dysfunction in ST-elevation myocardial infarction: cause, consequence, or both?
Eur. Heart J., April 1, 2007; 28(7): 788 - 797.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
P. Ortolani, A. Marzocchi, C. Marrozzini, T. Palmerini, F. Saia, C. Serantoni, M. Aquilina, S. Silenzi, F. Baldazzi, D. Grosseto, et al.
Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction
Eur. Heart J., July 1, 2006; 27(13): 1550 - 1557.
[Abstract] [Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement