Distribution and determinants of myocardial perfusion grade following late mechanical recanalization of occluded infarct‐related arteries postmyocardial infarction: A report from the occluded artery trial

Jorapur, Vinod; Steigen, Terje K.; Buller, Christopher E.; Džavík, Vladimir; Webb, John G.; Strauss, Bradley H.; Yeoh, Eunice; Kurray, Peter; Sokalski, Leszek; Machado, Maurício Cavalieri; Kronsberg, Shari S.; Lamas, Gervasio A.; Hochman, Judith S.; Mancini, G.B. John

doi:10.1002/ccd.21745

Cited by 6 publications

(6 citation statements)

References 42 publications

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“…(Tables 1 and 2). These baseline findings are similar to those reported for the larger cohort of 261 OAT ancillary study patients in whom baseline MPG was measured 16 .…”

Section: Resultssupporting

confidence: 86%

“…We found fewer collaterals, significantly more LAD occlusions and a greater likelihood of unsuccessful fibrinolytic therapy in the MPG 0/1 group. These findings are similar to those reported for the larger cohort of 261 OAT ancillary study patients in whom baseline MPG was measured 16 and in correspondence with data published by Kandzari et al 25 from a study of primary percutaneous revascularization in acute myocardial infarction, showing that anterior infarction is associated with greater impairment of LVEF, less frequent collateral flow and diminished reperfusion success as measured by MPG.…”

Section: Discussionsupporting

confidence: 90%

“…We reported in our previous publication 16 , that failed fibrinolytic therapy was significantly associated with impaired MPG following late recanalization of occluded IRAs by PCI. The association was no longer significant when adjusted for multiple variables that correlate with infarct size.…”

Section: Discussionmentioning

confidence: 87%

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Myocardial Perfusion Grade After Late Infarct Artery Recanalization Is Associated With Global and Regional Left Ventricular Function at One Year

Steigen

Buller

Mancini

et al. 2010

Circ: Cardiovascular Interventions

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Background Whether myocardial perfusion grade (MPG) following late recanalization of infarct-related arteries (IRA) predicts left ventricular (LV) function recovery beyond the acute phase of myocardial infarction (MI) is unknown. Methods and Results The Total Occlusion Study of Canada-2 (TOSCA-2) enrolled stable patients with persistently occluded IRA beyond 24 h and up to 28 days post-MI. We studied the relationship between the initial MPG and changes in LV function and volume, and the change in MPG from immediate post-PCI to one year in 139 PCI patients with TIMI 3 epicardial flow post PCI and with paired values, grouped into impaired or good MPG groups (MPG 0/1 or MPG 2/3). MPG 0/1 patients were more likely to have received thrombolytic therapy and to have a LAD IRA. They had lower blood pressure and LV ejection fraction (LVEF), and a higher heart rate and systolic sphericity index at baseline. Changes in the MPG 0/1 and MPG 2/3 groups from baseline to 1 year were: LVEF 3.3±9.0 and 4.8±8.9 percent (p=0.42), LV end-systolic volume index (LVESVI) -1.1±9.2 and -4.7±12.3 ml/m2 (p=0.25), LV end-diastolic volume index (LVEDVI) 0.08±19.1 and -2.4±22.2 ml/m2 (p=0.67), and standard deviations /chord for infarct zone wall motion index (WMI)) 0.38±0.70 and 0.84±1.11 (p=0.01). By covariate-adjusted analysis, post-PCI MPG 0/1 predicted lower WMI (p<0.001), lower LVEF (p<0.001) and higher LVESVI (p<0.01), but not LVEDVI at one year. Of the MPG 0/1 patients, 60% were MPG 2 or 3 at one year. Conclusions Preserved MPG is present in a high proportion of patients following late PCI of occluded IRAs post-MI. Poor MPG post-PCI frequently improves MPG over 1 year. MPG graded after IRA recanalization undertaken days to weeks post MI is associated with LV recovery indicating that MPG determined in the subacute post-MI period remains a marker of viability.

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“…(Tables 1 and 2). These baseline findings are similar to those reported for the larger cohort of 261 OAT ancillary study patients in whom baseline MPG was measured 16 .…”

Section: Resultssupporting

confidence: 86%

Section: Discussionsupporting

confidence: 90%

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Myocardial Perfusion Grade After Late Infarct Artery Recanalization Is Associated With Global and Regional Left Ventricular Function at One Year

Steigen

Buller

Mancini

et al. 2010

Circ: Cardiovascular Interventions

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“…Collateral flow may prolong the maximal time of coronary occlusion before reperfusion when irreversible transmural myocardial necrosis develops, and reduce infarct size [19]. Well-developed collaterals (C2) before reperfusion by PCI in patients with STEMI are associated with a protective effect on coronary microcirculation and decreasing no-reflow [20,21].…”

Section: Discussionmentioning

confidence: 99%

Independent no-reflow predictors in female patients with ST-elevation acute myocardial infarction treated with primary percutaneous coronary intervention

et al. 2011

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Independent no-reflow predictors should be evaluated in female patients with ST-segment elevation acute myocardial infarction (STEMI) and successfully treated with primary percutaneous coronary intervention (PPCI) in the current interventional equipment and techniques, thus to be constructed a no-reflow predicting model. In this study, 320 female patients with STEMI were successfully treated with PPCI within 12 h after the onset of AMI from 2007 to 2010. All clinical, angiographic, and procedural data were collected. Multiple logistic regression analysis was used to identify independent no-reflow predictors. The no-reflow was found in 81 (25.3%) of 320 female patients. Univariate and multivariate stepwise logistic regression analysis identified that low SBP on admission <100 mmHg (OR 1.991, 95% CI 1.018-3.896; p = 0.004), target lesion length >20 mm (OR 1.948, 95% CI 1.908-1.990; p = 0.016), collateral circulation 0-1 (OR 1.952, 95% CI 1.914-1.992; p = 0.019), pre-PCI thrombus score ≥ 4 (OR 4.184, 95% CI 1.482-11.813; p = 0.007), and IABP use before PCI (OR 1.949, 95% CI 1.168-3.253; p = 0.011) were independent no-reflow predictors. The no-reflow incidence significantly increased as the numbers of independent predictors increased [0% (0/2), 10.8% (9/84), 14.5% (17/117), 37.7% (29/77), 56.7% (17/30), and 81.8% (9/11) in female patients with 0, 1, 2, 3, 4, and 5 independent predictors, respectively; p < 0.0001]. The five no-reflow predicting variables were admission SBP <100 mmHg, target lesion length >20 mm, collateral circulation 0-1, pre-PCI thrombus score ≥ 4, and IABP use before PCI in female patients with STEMI treated with PPCI.

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“…This could lead to poorer collateral blood flow, associated with impaired microvascular blood flow in the risk area. 27,28 Thus, the evaluation of microvascular damage on LGE images may allow the selection of specific patients with severely impaired myocardial perfusion.…”

Section: Microvascular Damage Assessed By First-pass and Lge Imagesmentioning

confidence: 99%

Prognostic Value of Microvascular Damage Determined by Cardiac Magnetic Resonance in Non ST-Segment Elevation Myocardial Infarction

Cochet¹,

Lalande²,

Lorgis³

et al. 2010

Investigative Radiology

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Distribution and determinants of myocardial perfusion grade following late mechanical recanalization of occluded infarct‐related arteries postmyocardial infarction: A report from the occluded artery trial

Cited by 6 publications

References 42 publications

Myocardial Perfusion Grade After Late Infarct Artery Recanalization Is Associated With Global and Regional Left Ventricular Function at One Year

Myocardial Perfusion Grade After Late Infarct Artery Recanalization Is Associated With Global and Regional Left Ventricular Function at One Year

Independent no-reflow predictors in female patients with ST-elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Prognostic Value of Microvascular Damage Determined by Cardiac Magnetic Resonance in Non ST-Segment Elevation Myocardial Infarction

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