Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients

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• 作者：Mathieu Julien Schaaf ; MD^a ; ¹ ; ^{Mathieu.schaaf@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Nathan Mewton ; MD ; PhD^a ; ^p ; ¹ ; Gilles Rioufol ; MD ; PhD^a ; Denis Angoulvant ; MD ; PhD^b ; Guillaume Cayla ; MD ; PhD^c ; Nicolas Delarche ; MD^d ; Bernard Jouve ; MD^e ; Patrice Guerin ; MD ; PhD^f ; Gerald Vanzetto ; MD ; PhD^g ; Pierre Coste ; MD ; PhD^h ; Olivier Morel ; MD ; PhDⁱ ; Franç ; ois Roubille ; MD ; PhD^j ; Meyer Elbaz ; MD ; PhD^k ; Olivier Roth ; MD^l ; Fabrice Prunier ; MD ; PhD^m ; Thien Tri Cung ; MD^j ; Christophe Piot ; MD ; PhD^j ; Ingrid Sanchez ; MD^a ; Eric Bonnefoy-Cudraz ; MD ; PhD^a ; Didier Revel ; MDⁿ ; Cé ; line Giraud ; MSc^a ; Pierre Croisille ; MD ; PhDⁿ ; ^o ; Michel Ovize ; MD ; PhD^a ; ^p
• 关键词：Magnetic resonance imaging ; Myocardial infarction ; Myocardial delayed enhancement ; Microvascular obstruction ; Coronary circulation
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：67
• 期：3
• 页码：248-253
• 全文大小：475 K

文摘

The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR).

Methods

In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72 h after admission.

Results

A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95 ± 0.02 vs. 2.97 ± 0.02, respectively; p = 0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32 ± 17 g vs. 21 ± 17 g, respectively; p = 0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p = 0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group.

Conclusion

Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.