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Time-dependent myocardial necrosis in patients suffering from ST-elevation myocardial infarction without angiographic collateral flow visualized by cardiac magnetic resonance imaging

Session Poster Session 3

Speaker Andreas Seitz

Event : ESC Congress 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease : Noninvasive Diagnostic Methods
  • Session type : Poster Session

Authors : S Greulich (Tuebingen,DE), A Mayr (Innsbruck,AT), S Gloekler (Villingen-Schwenningen,DE), A Seitz (Stuttgart,DE), S Birkmeier (Stuttgart,DE), T Schaeufele (Stuttgart,DE), R Bekeredjian (Stuttgart,DE), CS Zuern (Basel,CH), T Geisler (Tuebingen,DE), G Klug (Innsbruck,AT), A Wahl (Bern,CH), B Metzler (Innsbruck,AT), M Gawaz (Tuebingen,DE), S Windecker (Bern,CH), H Mahrholdt (Stuttgart,DE)

S Greulich1 , A Mayr2 , S Gloekler3 , A Seitz4 , S Birkmeier4 , T Schaeufele4 , R Bekeredjian4 , CS Zuern5 , T Geisler1 , G Klug6 , A Wahl7 , B Metzler6 , M Gawaz1 , S Windecker7 , H Mahrholdt4 , 1University of Tuebingen - Tuebingen - Germany , 2University of Innsbruck , Radiology - Innsbruck - Austria , 3Schwarzwald-Baar Hospital, Cardiology - Villingen-Schwenningen - Germany , 4Robert Bosch Hospital, Department of Cardiology - Stuttgart - Germany , 5University Hospital Basel, Cardiology - Basel - Switzerland , 6University of Innsbruck , Cardiology - Innsbruck - Austria , 7Bern University Hospital, Cardiology - Bern - Switzerland ,


Background: Acute complete occlusion of a coronary artery results in progressive ischemia, moving from the endocardium to the epicardium ("wavefront"). Dependent on time-to-reperfusion and collateral flow, myocardial infarction (MI) will manifest, with transmural MI portending poor prognosis. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging can detect MI with high diagnostic accuracy. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients with STEMI <12 hours of symptom onset.

Purpose: We sought to visualize time-dependent necrosis in a ST-segment elevation myocardial infarction (STEMI) population by LGE-CMR.

Methods: STEMI patients with: single-vessel disease, complete occlusion with Thrombolysis in Myocardial Infarction (TIMI) score 0, absence of collateral flow (Rentrop score 0) and symptom onset <12 hours were consecutively enrolled. By LGE-CMR, area at risk (AAR) and infarct size (IS), myocardial salvage index (MSI), transmurality index, and transmurality grade (0-50%, 51-75%, 76-100%) were determined.

Results: 164 patients (54±11 years, 80% male) were included. Receiver-operating-characteristic (ROC)-curve (area under the curve [AUC] = 0.81) indicating transmural necrosis revealed the best diagnostic cut-off for a symptom-to-balloon time of 121 minutes, i.e. patients with >121 minutes demonstrated increased IS, transmurality index, transmurality grade (all p-values <0.01), and decreased MSI (p<0.001) vs. patients with symptom-to-balloon times =121 minutes.

Conclusions: In myocardial infarction with no residual antegrade, and no collateral flow, immediate reperfusion is vital. A symptom-to-balloon time of >121 minutes causes a high grade of transmural necrosis. In the present, pure STEMI population, time to reperfusion to salvage myocardium was less than suggested by current guidelines.

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