P3096The cardioprotective effect of FFR-significant multivessel disease detected by cardiac magnetic resonance imaging in patients following ST-segment elevation myocardial infarction. Results from DANAMI3

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Ekstroem ◽  
J V W Nielsen ◽  
L Nepper-Christensen ◽  
K A Ahtarovski ◽  
K Kyhl ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Short Axis Slice ◽  
Myocardial Salvage ◽  
Area At Risk ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Remote Ischemic Perconditioning ◽  
Final Infarct Size

Abstract Background In patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), reperfusion injury accounts for a significant part of the final infarct size, which is directly related to patient prognosis. In animal studies brief periods of ischemia in non-infarct related coronary arteries protects the myocardium via remote ischemic perconditioning. Fractional flow reserve (FFR) measures functional significant coronary stenosis which may offer remote ischemic perconditioning of the myocardium. It has not previously been investigated if FFR-significant stenosis in non-culprit myocardium offers cardioprotection following STEMI. Purpose To investigate cardioprotective effect of FFR-significant multivessel disease (MVD) on final infarct size and myocardial salvage in a large contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI). Methods and results We included 509 patients with STEMI from the DANAMI-3 trial, divided into three groups: 388 (76%) patients had single vessel disease (SVD), 34 (7%) had non-FFR-significant MVD and 192 (17%) had FFR-significant MVD. CMR was performed at baseline and three months after primary PCI. There was no difference in final infarct size; mean infarct size (% left ventricular mass) SVD 9±3%; non-FFR-significant MVD 9±3%; and FFR-significant MVD 9±3%, p=0.95, or in myocardial salvage index (MSI) between groups, calculated as (area-at-risk – infarct size)/area-at-risk; mean index (%) SVD 67±23%; non-FFR-significant MVD 68±19%; and FFR-significant MVD 67±21%, p=0,99. In multivariable regression analyses FFR-significant MVD was not associated med larger MSI (p=0.84) or lower infarct size (p=0.60). Figure 1. A. Late gadolinium (LGE) cardiac magnetic resonance (CMR) image of a mid-ventricular short-axis slice. Hyperintense signals (arrow) shows contrast enhancement in the anterior-septal segments, indicating myocardial infarction (MI). B. Same patient. T2-weighted image of the same mid-ventricular short-axis slice. Hyperintense signals (arrows) shows edema in the anterior-septal segments. Conclusions FFR-significant functional MVD of non-culprit myocardium does not offer cardioprotection in patients following STEMI.

scholarly journals Combined protocol for remote ischemic conditioning as the method of cardioprotection in patients with acute ST-segment elevation myocardial infarction

2021 ◽  
Vol 36 (2) ◽  
pp. 76-83
Author(s):  
E. A. Koreneva ◽  
T. L. Denisevich ◽  
A. G. Mrochek ◽  
V. I. Stelmashok
Keyword(s):  
Myocardial Infarction ◽  
Microvascular Obstruction ◽  
Intervention Group ◽  
Group Versus ◽  
Control Group ◽  
Myocardial Salvage ◽  
Area At Risk ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background. There is currently no commonly accepted strategy for limiting the reperfusion injury that occurs after revascularization in patients with myocardial infarction. This study aimed to investigate the efficacy of a promising cardioprotective method.Material and Methods. Patients with acute anterior ST-segment elevation myocardial infarction (STEMI) (n = 87) were included in an open-label prospective randomized controlled trial. Control group comprised patients with STEMI who underwent only primary percutaneous coronary intervention (PPCI) (n = 44). Patients of intervention group (n = 43) underwent PPCI and remote ischemic perconditioning combined with postconditioning (RIC). The efficacy of RIC was assessed based on cardiac magnetic resonance (CMR) imaging data.Results. The medians of left ventricular (LV) infarct size were significantly higher in patients of control group: 44.8 (33.6; 55.5) versus 52.7 (35.5; 73.9) mL (p = 0.039) at day 10 after STEMI and 34.0 (25.8; 39.8) mL versus 46.0 (32.8; 55.0) mL six months after STEMI in control and intervention groups, respectively (p = 0.004). The groups of patients did not differ in the sizes of area at risk relative to the total LV myocardial volume: 40 (35; 45) and 43 (34; 49)% in control and intervention groups, respectively (р = 0.232). The groups significantly differed in the ratios of infarct size to area at risk: 70.3 (65.1; 86.6)% in control group versus 63.5 (52.7; 72.0)% in intervention group (р = 0.014) as well as in the myocardial salvage indexes: 29.7 (13.5; 34.9)% in control group versus 36.5 (28.0; 47.3)% in intervention group (р = 0.014). The study showed the tendency to greater LV myocardial salvage in intervention group versus control group at six-months follow-up (р = 0.073). The groups significantly differed in the medians of microvascular obstruction volume: 1.9 (1.4; 2.9) mL in intervention group versus 2.5 (1.8; 8.1) mL in control group (p = 0.049) as well as in the proportions of microvascular obstruction in the LV myocardium: 0.94 (0.79; 1.37)% in intervention group versus 1.50 (0.89; 3.66)% in control group (р = 0.046).Conclusion. The RIC method combined with PPCI contributed to the limitation of infarct and microvascular obstruction sizes and was associated with an increase in the myocardial salvage index in STEMI patients.

scholarly journals Infarct size following loading with ticagrelor/prasugrel versus clopidogrel in ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Sabbah ◽  
L Nepper-Christensen ◽  
L Koeber ◽  
D Eik Hoefsten ◽  
K Aleksov Ahtarovski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Infarct Size ◽  
Coronary Intervention ◽  
Myocardial Salvage ◽  
Funding Source ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background Treatment with newer direct-acting anti-platelet drugs (Ticagrelor and Prasugrel) prior to primary percutaneous coronary intervention (PCI) is associated with improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) when compared with Clopidogrel. Purpose We retrospectively compared infarct size following non-randomized treatment with Ticagrelor/Prasugrel versus Clopidogrel in a population of STEMI patients treated with primary PCI. Methods Patients were loaded with Clopidogrel, Ticagrelor or Prasugrel in the ambulance before primary PCI. Infarct size and myocardial salvage index were calculated using cardiac magnetic resonance (CMR) during index admission and at three-month follow-up. Results 693 patients were included in this analysis. Clopidogrel was given to 351 patients and Ticagrelor/Prasugrel to 342 patients. The groups were generally comparable in terms of baseline and procedural characteristics. Median infarct size at three-month follow-up was 12.9% vs 10.0%, in patients treated with Clopidogrel and Ticagrelor/ Prasugrel respectively (p<0.001), and myocardial salvage index was 66% vs 71% (p<0.001). Results remained significant in a multiple regression model (p<0.001). Conclusion Pre-hospital loading with Ticagrelor or Prasugrel compared to Clopidogrel, was associated with smaller infarct size and larger myocardial salvage index at three-month follow-up in patients with STEMI treated with primary PCI. Infarct size at three month follow-up Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Novo Nordisk Foundation. The Alfred Benzon Foundatioun.

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