Long-Term Prognostic Value of Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance in Acute Reperfused Myocardial Infarction

Eitel, Ingo; Desch, Steffen; Waha, Suzanne de; Fuernau, Georg; Gutberlet, Matthias; Schuler, Gerhard; Thiele, Holger

doi:10.1016/s0735-1097(11)60632-3

Cited by 6 publications

(7 citation statements)

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“…Myocardial salvage in response to reperfusion therapy with PCI is the major strategy for limiting infarct size therapeutically and can now be quantified by cardiovascular magnetic resonance (CMR). A study of 208 patients presenting with STEMI confirmed that the extent of salvage measured by CMR is closely related to long-term prognosis, patients with a myocardial salvage index (MSI) above the median level having a lower number of adverse cardiovascular events (7 vs. 26) and deaths (2 vs. 12) after 18.5 months than patients with MSI below the median level (77). Myocardial reperfusion, however, can itself exacerbate injury, by a variety of mechanisms which include interstitial haemorrhage.…”

Section: Infarct Size and Myocardial Salvagementioning

confidence: 97%

Almanac 2012: interventional cardiology

Meier¹

2012

Anadolu Kardiyol Derg

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Section: Infarct Size and Myocardial Salvagementioning

confidence: 97%

Almanac 2012: interventional cardiology

Meier¹

2012

Anadolu Kardiyol Derg

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“…Measurements of the area-at-risk, infarct size, and microvascular obstruction were expressed as the percentage of left ventricular (LV) volume (%LV). Myocardial salvage index was determined from area at risk and infarct size as previously described [13]. As described previously [20], LV function was available for 792 patients.…”

Section: Cardiovascular Magnetic Resonancementioning

confidence: 99%

“…However, whether differences in myocardial salvage, infarct size or microvascular injury contribute to the adverse outcome in contemporary reperfused MI patients is unknown. Cardiovascular magnetic resonance (CMR) is the reference technique for the determination of these infarct characteristics [12], which are known to be strongly correlated with clinical prognosis in patients with ST-elevation MI (STEMI) reperfused by primary percutaneous coronary intervention (PPCI) [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Antecedent Hypertension and Myocardial Injury in Patients With Reperfused St-Elevation Myocardial Infarction

Reinstadler

Stiermaier

Eitel

et al. 2017

Journal of the American College of Cardiology

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Background: Antecedent hypertension is associated with poor outcome in patients with ST-elevation myocardial infarction (STEMI). Whether differences in myocardial salvage, infarct size and microvascular injury contribute to the adverse outcome is unknown. We investigated the association between antecedent hypertension and cardiovascular magnetic resonance (CMR) parameters of myocardial salvage and damage in a multicenter CMR substudy of the AIDA-STEMI trial (Abciximab Intracoronary versus intravenously Drug Application in ST-elevation myocardial infarction). Methods: We analyzed 792 consecutive STEMI patients reperfused within 12 h after symptom onset. Patients underwent CMR imaging for assessment of myocardial salvage, infarct size and microvascular obstruction within 10 days after infarction. Major adverse cardiac events (MACE) were recorded at 12-month follow-up. Results: Antecedent hypertension was present in 540 patients (68 %) and was associated with a significantly increased baseline risk profile (advanced age, higher body mass index, higher incidence of diabetes, hypercholesterolemia, previous angioplasty and multivessel disease, p < 0.001 for all). MACE were more frequent in patients with hypertension as compared to patients without hypertension (45 [8 %] vs. 8 [3 %], p < 0.01). Antecedent hypertension remained an independent predictor of MACE after multivariate adjustment (hazard ratio 3.42 [confidence interval 1.45-8.08], p < 0.01). There was, however, no significant difference in the area at risk, infarct size, myocardial salvage index, extent of microvascular obstruction, and left ventricular ejection fraction between the groups (all p > 0.05).

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“…A study of 208 patients presenting with STEMI confirmed that the extent of salvage measured by CMR is closely related to long-term prognosis, patients with a myocardial salvage index (MSI) above the median level having a lower number of adverse cardiovascular events (7 vs 26) and deaths (2 vs 12) after 18.5 months than patients with MSI below the median level. 77 Myocardial reperfusion, however, can itself exacerbate injury, by a variety of mechanisms which include interstitial haemorrhage. This can be detected by CMR and was reported in 25% of patients with STEMI treated successfully by primary PCI.…”

Section: Infarct Size and Myocardial Salvagementioning

confidence: 99%

Almanac 2012: Interventional cardiology

Meier

2013

Revista Portuguesa de Cardiologia (English Edition)

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The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multivessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor) and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including alcohol septal ablation for hypertrophic obstructive cardiomyopathy, etc. At the moment, the fastest growing area is the structural interventions, especially for aortic valve stenosis (transcatheter aortic valve implantation TAVI) and for mitral regurgitation (mitral clipping). This review covers recent advances in all these different fields of interventional cardiology. PERCUTANEOUS CORONARY INTERVENTION VERSUS MEDICAL TREATMENTPercutaneous coronary intervention (PCI) has guideline recommendations for treatment of ST elevation and non-ST elevation myocardial infarction (MI). 1 However, its role in stable coronary disease has been the subject of reappraisal following publication of the COURAGE trial, which showed that, in patients receiving optimal medical therapy, PCI does not improve cardiovascular outcomes, while incremental benefits for quality of life disappear by 36 months. A more recent meta-analysis of eight trials of optimal medical therapy versus PCI involving 7229 patients bears out the COURAGE conclusions by showing no significant differences between the groups with regard to death (9.1% vs 8.9%), non-fatal MI (8.1% vs 8.9%), unplanned revascularisation (30.7% vs 21.4%) and persistent angina (33% vs 29%).4 Drug-eluting stents (DESs) were used in only a minority of these patients and may have reduced the need for further revascularisation while improving symptomatic responses. Nevertheless, the meta-analysis reinforces contemporary guideline advice for optimal medical treatment as the initial treatment for stable angina.

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Long-Term Prognostic Value of Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance in Acute Reperfused Myocardial Infarction

Cited by 6 publications

References 0 publications

Almanac 2012: interventional cardiology

Almanac 2012: interventional cardiology

Antecedent Hypertension and Myocardial Injury in Patients With Reperfused St-Elevation Myocardial Infarction

Almanac 2012: Interventional cardiology

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