Document Detail


Improving myocardial salvage in late presentation acute ST-elevation myocardial infarction with proximal embolic protection.
MedLine Citation:
PMID:  20506154     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Late-presenting ST-elevation myocardial infarction (STEMI) patients possess larger, more organized coronary thrombus leading to greater ventricular remodeling and arrhythmia despite angioplasty and pharmacological therapies. We hypothesized that myocardial injury would be reduced in late STEMI by proximal embolic protection (PEP).
METHODS: 31 patients with first STEMI 12-24 hr after pain onset and TIMI 0-1 flow were treated with or without PEP (cohort design matched for age, gender, and infarct-related artery). Contrast-enhanced magnetic resonance determined myocardial function, area at risk, necrosis, salvaged myocardium, and arrythmogenic peri-infarct region. Clinical follow-up was performed.
RESULTS: Pain to balloon time was 18 hr (95% CI 15.5-21.2 h), and Q waves were present in 87%. Angioplasty was performed with PEP in 15 and without in 16. Left ventricular (LV) volumes and ejection fraction were similar (EF 46.9% vs. 49.0% without PEP, P = 0.9). Although myocardial necrosis was similar (32.5 vs. 37.3% of LV, P = 0.3), PEP improved microvascular obstruction (8.7 vs. 11.2% of LV, P = 0.02) salvaged myocardium (39.6% vs. 29.6% of area at risk, P = 0.001), and the peri-infarct region (20.9 vs. 29.6% of infarct, P < 0.0001). On multivariate analysis, the use of PEP was an independent predictor of decreased arrythmogenic peri-infarct region and greater myocardial salvage.
CONCLUSION: In this pilot study, PEP improved myocardial salvage and the arrythmogenic peri-infarct region in late-presentation STEMI. Randomized trials are required to assess the clinical impact of improving salvaged myocardium and the peri-infarct region with PEP.
Authors:
Eric Larose; Helena Tizon-Marcos; Josep Rodés-Cabau; Stéphane Rinfret; Jean-Pierre Déry; Can M Nguyen; Onil Gleeton; Jean-Rock Boudreault; Louis Roy; Bernard Noël; Guy Proulx; Jacques Rouleau; Gérald Barbeau; Robert De Larochellière; Olivier F Bertrand
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  76     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  461-70     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley-Liss, Inc.
Affiliation:
Cardiac Catheterization Laboratories, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval, Québec, Canada. Eric.Larose@criucpq.ulaval.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / adverse effects,  instrumentation*
Arrhythmias, Cardiac / etiology,  prevention & control
Contrast Media / diagnostic use
Coronary Angiography
Coronary Circulation
Coronary Thrombosis / complications,  pathology,  physiopathology,  therapy*
Embolic Protection Devices*
Embolism / etiology,  pathology,  physiopathology,  prevention & control*
Female
Humans
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardial Infarction / etiology,  pathology,  physiopathology,  therapy*
Myocardium / pathology*
Necrosis
Pilot Projects
Prospective Studies
Quebec
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Chemical
Reg. No./Substance:
0/Contrast Media
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2010 Oct 1;76(4):471-2   [PMID:  20882646 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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