2002 Predictors of infarct size and microvascular obstruction assessed by magnetic resonance imaging in patients with ST
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Meeting abstract
2002 Predictors of infarct size and microvascular obstruction assessed by magnetic resonance imaging in patients with STEMI undergoing primary PCI Holger Thiele*, Josef Friedenberger, Kathrin Schindler, Ingo Eitel, Eigk Grebe, Mathias Gutberlet, Dietmar Kivelitz and Gerhard Schuler Address: University of Leipzig – Heart Center, Leipzig, Germany * Corresponding author
from 11th Annual SCMR Scientific Sessions Los Angeles, CA, USA. 1–3 February 2008 Published: 22 October 2008 Journal of Cardiovascular Magnetic Resonance 2008, 10(Suppl 1):A271
doi:10.1186/1532-429X-10-S1-A271
Abstracts of the 11th Annual SCMR Scientific Sessions - 2008
Meeting abstracts – A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/pdf/1532-429X-10-S1-info.pdfThis abstract is available from: http://jcmr-online.com/content/10/S1/A271 © 2008 Thiele et al; licensee BioMed Central Ltd.
Introduction Infarct size (IS) and presence of microvascular obstruction (MO) assessed by delayed enhancement MRI are associated with mortality in ST-elevation myocardial infarction (STEMI). The time-to-reperfusion, electrocardiographic and angiographic parameters are also of prognostic relevance in STEMI patients. Predictors of IS and MO occurrence have not been assessed so far in an adequately large trial.
Purpose To assess predictors of infarct size and microvascular obstruction.
Methods This study analyzed 136 consecutive STEMI patients reperfused by primary PCI within 12 hours after symptom onset. IS and MO were assessed by delayed enhancement MRI as percentage of left ventricular mass (%LV) 3.1 ± 4.1 days after the index event. Reperfusion times, 90 min STsegment resolution, TIMI-flow grades pre and post PCI, TIMI risk score and multiple clinical parameters such as cardiovascular risk factors, Killip-class, and infarct location were assessed.
affected by the pre PCI TIMI flow. The post PCI TIMI flow had no significant effect on final IS and MO occurrence. In patients with TIMI flow < 3 IS was 25 ± 13% versus 21 ± 15% in TIMI-flow = 3 (p = 0.24). The ST-segment resolution correlated inversely with final IS and presence of MO (IS r = -0.34, p = 0.003; MO r = -0.31, p = 0.004). Anterior MI IS was 25 ± 16% (MO 7.8 ± 9.8%) versus 17 ± 12% (MO 3.8 ± 4.7%) in inferior MI (p = 0.002 IS; p = 0.003 MO). According to quintiles of time-to-reperfusion, there was no interaction between time-to-reperfusion and IS and extent of MO even when restricted to patients with pre PCI TIMI flow 0–1. In a multivariable model the strongest predictors of IS and MO were pre-PCI TIMI-flow, infarct location, Killip class, and 90 minute ST-segment resolution (p < 0.005 for all).
Conclusion The pre-PCI TIMI flow, infarct location, Killip class and ST-segment resolution are the strongest predictors of IS and extent of MO. This may explain why these clinical, angiographic and electrocardiographic measures are associated with survival. In contrast to other studies the ti
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