Myocardial salvage and infarct size in acute myocardial infarction assessed by magnetic resonance imaging - Influences b
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BioMed Central
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Myocardial salvage and infarct size in acute myocardial infarction assessed by magnetic resonance imaging - Influences by prehospital initiated facilitated PCI versus primary PCI in early infarct presenters Holger Thiele*, Ingo Eitel, Claudia Meinberg, Matthias Gutberlet and Gerhard Schuler Address: University of Leipzig - Heart Center, Leipzig, Germany * Corresponding author
from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010 Published: 21 January 2010 Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):P206
doi:10.1186/1532-429X-12-S1-P206
Abstracts of the 13th Annual SCMR Scientific Sessions - 2010
Meeting abstracts - A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-infoThis abstract is available from: http://jcmr-online.com/content/12/S1/P206 © 2010 Thiele et al; licensee BioMed Central Ltd.
Introduction Myocardial salvage (MS) can be assessed retrospectively by T2-weighted and delayed enhancement images as shown in animal studies. Currently there is limited data in humans and this technique has not been used for the assessment in multicenter trials comparing different reperfusion regimens in STEMI. Facilitated PCI with fibrinolysis did not show a benefit in comparison to primary PCI in recently published trials. However, a subgroup of high-risk STEMI patients presenting early after symptom onset, treated with optimal antiplatelet co-medication, and with long transfer times might benefit from a fibrinolytic-based facilitated PCI.
Purpose Aim of this trial was to establish MS imaging as a surrogate endpoint in a randomized multicenter trial and to show that facilitated PCI versus primary PCI in a STEMI network with long transfer distances up to 70 km is beneficial with respect to infarct size (IS) and MS.
rin. The primary endpoint was IS assessed by delayed enhancement. Secondary endpoints were microvascular obstruction and MS assessed by MRI, ST-resolution at 90 min., and a composite of death, re-MI, and congestive heart failure at 30 day follow-up.
Results All images were assessable for the calculation of the MS index. The median time from symptom-onset to randomization was 64 min (IQR 42;103) in group A versus 55 min in group B (IQR 27;91; p = 0.26). Despite better preinterventional TIMI-flow in group A (76% versus 28% TIMI 2 or 3; P < 0.001) IS size was similar in group A versus B (14.1% of left ventricle [IQR 5.3;26.7] versus 15.1% [IQR 7.5;23.3]; p = 0.75). There was also no difference in microvascular obstruction, MS (p = 0.65 and 0.71) and a trend towards worse ST-segment resolution (p = 0.07). The combined clinical endpoint showed a trend towards higher event rates in group A (18.9% versus 8.1%; p = 0.09, relative risk 2.33, 95% confidence interval, 0.985.63).
Methods Patients with STEMI (
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