Document Detail


Influence of time-to-treatment, TIMI-flow grades, and ST-segment resolution on infarct size and infarct transmurality as assessed by delayed enhancement magnetic resonance imaging.
MedLine Citation:
PMID:  17556347     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: The time-to-treatment, ST-segment resolution (STR), and TIMI-flow might be associated with infarct size (IS) and infarct transmurality in humans. Delayed enhancement magnetic resonance imaging (DE-MRI) has excellent spatial resolution to uncover these relations. METHODS AND RESULTS: This study analysed 135 ST-elevation myocardial infarction (STEMI) patients randomized to prehospital fibrinolysis or prehospital initiated facilitated percutaneous coronary intervention (PCI). Reperfusion-times, 90 min STR, and TIMI-flow grades were assessed. IS at 6-month follow-up was determined as percentage of left ventricular mass (% LV). Transmurality was defined if segments exceeded > 50% DE. The median time-to-treatment was 93 min [interquartile range (IQR) 66.5; 158.8] for prehospital fibrinolysis and 85 min (IQR 60.0; 143.5) for facilitated PCI patients (P = 0.35). In facilitated PCI, the pre-interventional TIMI-flow correlated with IS [TIMI 0-1 10.8% LV (IQR 7.6; 17.3) vs. TIMI 2-3 3.9% LV (IQR 0.9; 9.6); P = 0.002] and segments with transmurality 1.5 (IQR 0.0; 3.0) vs. 0 (IQR 0.0; 1.5; P = 0.02). In a multivariable model, incomplete STR < 70% was the strongest predictor of high IS [odds ratio (OR) 6.96, P < 0.001] and transmurality (OR 5.71, P < 0.001) followed by time-to-treatment delay (OR/30 min, 1.24; P = 0.01 for high IS and 1.23, P = 0.01 for transmurality). CONCLUSION: Time-to-treatment, STR, and TIMI-flow correlate with IS and transmurality underlining the assumed pathophysiological link between early flow restoration and perfusion in the infarct-related artery.
Authors:
Holger Thiele; Mathias J Kappl; Axel Linke; Sandra Erbs; Enno Boudriot; Alexander Lembcke; Dietmar Kivelitz; Gerhard Schuler
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2007-06-06
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-21     Completed Date:  2007-12-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1433-9     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine/Cardiology, University of Leipzig-Heart Centre, Strümpellstr. 39, 04289 Leipzig, Germany. thielh@medizin.uni-leipzig.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Angiography
Coronary Circulation*
Electrocardiography
Female
Fibrinolytic Agents / therapeutic use*
Heart Conduction System
Humans
Magnetic Resonance Imaging*
Male
Middle Aged
Myocardial Infarction / diagnosis*,  physiopathology,  therapy*
Regional Blood Flow
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents

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


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