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

Abstract Objective 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...

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Published in:Journal of cardiology 2016-03, Vol.67 (3), p.248-253
Main Authors: Schaaf, Mathieu Julien, MD, Mewton, Nathan, MD, PhD, Rioufol, Gilles, MD, PhD, Angoulvant, Denis, MD, PhD, Cayla, Guillaume, MD, PhD, Delarche, Nicolas, MD, Jouve, Bernard, MD, Guerin, Patrice, MD, PhD, Vanzetto, Gerald, MD, PhD, Coste, Pierre, MD, PhD, Morel, Olivier, MD, PhD, Roubille, François, MD, PhD, Elbaz, Meyer, MD, PhD, Roth, Olivier, MD, Prunier, Fabrice, MD, PhD, Cung, Thien Tri, MD, Piot, Christophe, MD, PhD, Sanchez, Ingrid, MD, Bonnefoy-Cudraz, Eric, MD, PhD, Revel, Didier, MD, Giraud, Céline, MSc, Croisille, Pierre, MD, PhD, Ovize, Michel, MD, PhD
Format: Article
Language:English
Subjects:
Aged
Cardiovascular
Coronary Angiography - methods
Coronary Circulation
Coronary Vessels - diagnostic imaging
Coronary Vessels - physiopathology
Embolism - etiology
Embolism - pathology
Female
Humans
Life Sciences
Magnetic resonance imaging
Male
Microvascular obstruction
Microvessels - pathology
Middle Aged
Myocardial delayed enhancement
Myocardial infarction
Myocardial Infarction - complications
Myocardial Infarction - pathology
Myocardial Infarction - surgery
Percutaneous Coronary Intervention
Preoperative Period
Prospective Studies
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Summary:Abstract Objective 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.
ISSN:0914-5087
1876-4738
DOI:10.1016/j.jjcc.2015.05.008