In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.


This content is currently on FREE ACCESS, enjoy another 80 days of free consultation

 

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

Congress : 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
  • FP Number : P2714

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)

Authors:
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 ,

Citation:

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.



Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from ESC Congress and ESC Asia with APSC & AFC
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s congress resources
  • 3Under 40 or in training - with a Combined Membership, access resources from all congresses
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are