Influence of infarct artery patency on the relation between initial ST segment elevation and 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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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

European Heart Journal ◽

10.1093/eurheartj/ehz745.0172 ◽

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.

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