Infarct size and myocardial salvage after primary angioplasty in patients presenting with symptoms for &lt;12 h vs. 12-72 h

Busk, Martin; Kaltoft, Anne; Nielsén, Sören; Bøttcher, Morten; Rehling, Michael; Thuesen, Leif; Bøtker, Hans Erik; Lassen, Jens Flensted; Christiansen, Evald Høj; Krusell, Lars Romer; Andersen, Henning; Nielsen, Torsten T.; Kristensen, Steen Dalby

doi:10.1093/eurheartj/ehp113

Cited by 91 publications

(57 citation statements)

References 31 publications

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“…Patients presenting between 12 and 24 h and possibly up to 60 h from symptom onset, even if pain free and with stable haemodynamics, may still benefit from early coronary angiography and possibly PCI [88,89]. Patients without ongoing chest pain or inducible ischaemia, presenting between 3 and 28 days with persistent coronary artery occlusion, did not benefit from PCI [90,91].…”

Section: Delayed Percutaneous Coronary Interventionmentioning

confidence: 99%

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Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

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Section: Delayed Percutaneous Coronary Interventionmentioning

confidence: 99%

“…As soon as possible IIb B [88,89] PCI after fibrinolysis Routine urgent PCI is indicated after successful fibrinolysis (resolved chest pain/discomfort and ST-segment elevation). e In order to reduce delay for patients with no reperfusion, transfer to PCI centre of all post-fibrinolysis patients is recommended.…”

Section: Circulatory Assistancementioning

confidence: 99%

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

View full text Add to dashboard Cite

“…Criteria for inclusion were as follows: (1) symptoms consistent with myocardial infarction lasting between 30 minutes and 12 hours, (2) ST-segment elevation of Ͼ0.1 mV in 2 or more contiguous leads, and (3) age Ͼ18 years. Patients were excluded from analysis on the basis of the following criteria: (1) previous coronary bypass surgery, (2) left bundle branch block, (3) treatment with fibrinolysis within the previous 30 days, (4) left main stenosis requiring coronary artery bypass surgery, (5) cardiogenic shock, and (6) previous myocardial infarction. During ambulance transfer, patients given a tentative diagnosis of STEMI were randomized to pPCI revascularization (pPCI alone [control group]) or pPCI revascularization plus remote conditioning (rICϩpPCI [intervention group]) through intermittent arm ischemia.…”

Section: Study Populationmentioning

confidence: 99%

“…3 However, abrupt restoration of blood flow may itself cause detrimental myocardial reperfusion injury, which possibly explains why a substantial number of patients with STEMI end up with low salvage, compromised LV function, and heart failure. 4 …”

mentioning

confidence: 99%

Remote Ischemic Conditioning in Patients With Myocardial Infarction Treated With Primary Angioplasty

Munk

Andersen

Schmidt

et al. 2010

Circ: Cardiovascular Imaging

112

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Background— We have found that remote ischemic conditioning (rIC), adjunctive to primary angioplasty, increases myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) and extensive myocardial area at risk (AAR). The present substudy aimed to evaluate the short-term effects of rIC on left ventricular (LV) function. Methods and Results— Patients with a first STEMI were randomized to rIC (4 cycles of 5 minutes upper-limb ischemia) during transfer to primary percutaneous coronary intervention (pPCI) (n=123) versus pPCI alone (n=119). Ejection fraction (EF), LV volumes, (2D and 3D echocardiography and myocardial perfusion imaging), and speckle-tracking global longitudinal strain were compared between treatment groups. There was no significant difference in LV function at day 1 (EF-2D, 0.51±0.10 versus 0.49±0.10; P =0.22) and after 30 days (EF-2D, 0.54±0.08 versus 0.53±0.10) between the rIC and the pPCI-alone groups. In patients with extensive AAR ≥35% of LV (n=53), EF after 30 days was higher after rIC than after pPCI alone (EF-2D, 0.51±0.07 versus 0.46±0.09; P =0.05). In patients with anterior infarction (n=97), rIC preserved LV function on day 1 (EF-2D, 0.51±0.11 versus 0.46±0.11; P =0.03) and persistently after 30 days (EF-2D, 0.55±0.08 versus 0.50±0.11; P =0.04; EF-myocardial perfusion imaging, 0.55±0.10 versus 0.49±0.12; P =0.02). These patients had similar AAR, whereas rIC reduced infarct size from 16% to 7% of LV ( P =0.01). Conclusions— Although no significant overall effect was observed, rIC seemed to result in modest improvement in LV function in high-risk patients prone to develop large myocardial infarcts. These results need to be confirmed in larger trials. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00435266.

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“…Early revascularization with percutaneous coronary intervention (PCI) or thrombolytic therapy is associated with significant clinical benefits, such as reduction in the size of infarction, improvement in left ventricular function and decreases in mortality [1][2][3] . Ventricular remodeling is a major determining factor for the post-infarct ventricular function and the long-term prognosis following acute MI (ref.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of serum collagen biomakers on the outcome of acute myocardial infarction treated with percutaneous coronary intervention

Gao¹,

Zhao²,

Ma³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. This study was designed to investigate the predictive value of serum collagen biomarkers on the outcomes of acute ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). Methods. Two hundred and ten patients with STEMI were successfully treated with PCI within 6 hrs ofthe onset of chest pain. The levels of serum procollagen type I carboxyterminal peptide (PICP) and procollagen type III peptide (PIIINP) were measured by enzymelinked immunosorbent assay (ELISA) before, 3 and 6 months after PCI. Left ventricular ejection fraction was assessed by echocardiography at 3 and 6 months after PCI. The composite endpoints were death by any cause, recurrent myocardial infarction, heart failure or stroke. Results. At the end of the 12-month follow up, 29 patients (13.8%) experienced an end point. The level of serum PICP in patients with an end point was higher than in patients without an end point 7 days (19.45 ± 2.17 vs 14.95 ± 3.07 ng/ mL, P<0.05) or 3 month after the PCI (29.87 ± 3.02 vs 22.14 ± 3.33 ng/mL, P<0.05). The serum PIIINP level in patients with an end point was also higher than those without 7 days after PCI (59.34 ± 4.23 vs 48.78 ± 4.23 ng/mL, P<0.05). Multivariate logistic regression analysis showed day 7 (OR=2.170, 95% CI 1.583-4.345, P=0.01) and 3-month serum PICP (OR=2.340, 95% CI 1.431-4.650, P=0.01) were independent predictors of composite end points. Conclusions. Persistent elevation of serum collagen marker PICP three months after PCI predicts an adverse outcome for patients with acute ST-elevation myocardial infarction.

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Infarct size and myocardial salvage after primary angioplasty in patients presenting with symptoms for <12 h vs. 12-72 h

Abstract: FIS is larger in late presenters (>12 h) than early presenters after primary angioplasty for STEMI. However, substantial myocardial salvage can be obtained beyond the 12 h limit, even when the infarct-related artery is totally occluded.

Cited by 91 publications

References 31 publications

Guidelines on myocardial revascularization

Guidelines on myocardial revascularization

Remote Ischemic Conditioning in Patients With Myocardial Infarction Treated With Primary Angioplasty

Predictive value of serum collagen biomakers on the outcome of acute myocardial infarction treated with percutaneous coronary intervention

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