The relationship between terminal QRS distortion on initial ECG and final infarct size at 4months in conventional ST- segment elevation myocardial infarct patients

Myocardial infarction remains the principal cause of death in Europe. In patients with ST-segment-elevation myocardial infarction (STEMI), a promptly revascularization with primary percutaneous intervention (PCI) has transformed prognosis in the last decades. However, despite increasing successful PCI procedures, mortality has remained unchanged in recent years. Also, due to an unsatisfactory reperfusion, some patients have significant myocardial damage and suffer left ventricular adverse remodeling with reduced function—all that resulting in the onset of heart failure with all its inherent clinical and socioeconomic burden. As a consequence of longer ischemic times, distal thrombotic embolization, ischemia-reperfusion injury and microvascular dysfunction, the resultant myocardial infarct size is the major prognostic determinant in STEMI patients. The improved understanding of all the pathophysiology underlying these events has derived to the development of several novel therapies aiming to reduce infarct size and to improve clinical outcomes in these patients. In this article, based on the mechanisms involved in myocardial infarction prognosis, we review the new interventional strategies beyond stenting that may solve the suboptimal results that STEMI patients still experience.

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Determinants of final infarct size and incidence of aborted infarction in patients treated with primary coronary intervention and adjunctive abciximab therapy

Nuklearmedizin ◽

10.3413/nukmed-0117 ◽

2008 ◽

Vol 47 (01) ◽

pp. 56-61 ◽

Cited By ~ 4

Author(s):

G. Parodi ◽

B. Sotgia ◽

D. Antoniucci ◽

A. Pupi ◽

R. Sciagrà

Keyword(s):

Regression Analysis ◽

Linear Regression ◽

Infarct Size ◽

Linear Regression Analysis ◽

Coronary Intervention ◽

Left Ventricular Ejection ◽

Killip Class ◽

St Segment Elevation ◽

St Segment ◽

Final Infarct Size

SummaryAims: Assess the determinants of final infarct size in patients successfully treated with primary percutaneous coronary intervention (PCI) and abciximab therapy and check whether infarct abortion may occur. Patients, methods: In 208 patients we examined the parameters that predict final infarct size and the incidence of aborted infarction, defined by completely normal perfusion and regional wall motion plus > 50% left ventricular ejection fraction (LVEF) in gated single-photon emission computed tomography (SPECT) acquired at one month. Results: In linear regression analysis, sex (p < 0.0001), high cholesterol (p < 0.05), Killip class (p < 0.0001), symptom-to-reperfusion time (p < 0.001), admission ST segment elevation (p < 0.0001), infarct related artery (p < 0.05), and pre-procedural TIMI flow (p < 0.002) were significant univariate predictors of final infarct size. In multiple linear regression analysis, symptom-to-reperfusion time (p < 0.001), Killip class (p < 0.0001), ST segment elevation (p < 0.003), and sex (p < 0.03) remained significant predictors, model R2 = 0.53. Aborted infarction was registered in 32 patients, more frequently female (59% versus 21%, p < 0.00001), older (p < 0.02), with larger prevalence of TIMI grade 3 (p < 0.05) and lower ST segment elevation at admission (p < 0.05). Conclusions: Sex, reperfusion delay, and initial infarct severity as indicated by Killip class and/or ST segment elevation appear the determinants of final infarct size in patients treated with primary PCI. The presence of aborted infarction seems related to the same factors and to preserved TIMI 3 flow.

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