Catheterization and Cardiovascular Interventions

Coronary Artery Disease

Improving myocardial salvage in late presentation acute ST-elevation myocardial infarction with proximal embolic protection^†

Corresponding Author

Eric Larose DVM, MD, FRCPC, FAHA

[email protected]

Cardiac catheterization laboratories and Cardiovascular magnetic resonance laboratory, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ, formerly Hôpital Laval), and Faculté de médecine, Université Laval, Québec, Canada

Cardiac catheterization laboratories and Cardiovascular magnetic resonance laboratory, Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 chemin Ste-Foy, Québec, QC, Canada G1V 4G5Search for more papers by this author

Helena Tizon-Marcos MD,

Helena Tizon-Marcos MD

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Josep Rodés-Cabau MD,

Josep Rodés-Cabau MD

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Stéphane Rinfret MD, MSc,

Stéphane Rinfret MD, MSc

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Jean-Pierre Déry MD, MSc,

Jean-Pierre Déry MD, MSc

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Can M. Nguyen MD,

Can M. Nguyen MD

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Onil Gleeton MD,

Onil Gleeton MD

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Jean-Rock Boudreault MD,

Jean-Rock Boudreault MD

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Louis Roy MD,

Louis Roy MD

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Bernard Noël MD,

Bernard Noël MD

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Guy Proulx MD,

Guy Proulx MD

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Jacques Rouleau MD,

Jacques Rouleau MD

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Gérald Barbeau MD,

Gérald Barbeau MD

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Robert De Larochellière MD,

Robert De Larochellière MD

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Olivier F. Bertrand MD, PhD,

Olivier F. Bertrand MD, PhD

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Eric Larose DVM, MD, FRCPC, FAHA,

Corresponding Author

Eric Larose DVM, MD, FRCPC, FAHA

[email protected]

Helena Tizon-Marcos MD,

Helena Tizon-Marcos MD

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Josep Rodés-Cabau MD,

Josep Rodés-Cabau MD

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Stéphane Rinfret MD, MSc,

Stéphane Rinfret MD, MSc

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Jean-Pierre Déry MD, MSc,

Jean-Pierre Déry MD, MSc

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Can M. Nguyen MD,

Can M. Nguyen MD

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Onil Gleeton MD,

Onil Gleeton MD

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Jean-Rock Boudreault MD,

Jean-Rock Boudreault MD

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Louis Roy MD,

Louis Roy MD

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Bernard Noël MD,

Bernard Noël MD

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Guy Proulx MD,

Guy Proulx MD

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Jacques Rouleau MD,

Jacques Rouleau MD

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Gérald Barbeau MD,

Gérald Barbeau MD

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Robert De Larochellière MD,

Robert De Larochellière MD

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Olivier F. Bertrand MD, PhD,

Olivier F. Bertrand MD, PhD

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First published: 15 April 2010

https://doi.org/10.1002/ccd.22588

Citations: 13

^†

Conflict of interest: Nothing to report.

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Abstract

Background: Late-presenting ST-elevation myocardial infarction (STEMI) patients possess larger, more organized coronary thrombus leading to greater ventricular remodeling and arrhythmia despite angioplasty and pharmacological therapies. We hypothesized that myocardial injury would be reduced in late STEMI by proximal embolic protection (PEP). Methods: 31 patients with first STEMI 12–24 hr after pain onset and TIMI 0–1 flow were treated with or without PEP (cohort design matched for age, gender, and infarct-related artery). Contrast-enhanced magnetic resonance determined myocardial function, area at risk, necrosis, salvaged myocardium, and arrythmogenic peri-infarct region. Clinical follow-up was performed. Results: Pain to balloon time was 18 hr (95% CI 15.5–21.2 h), and Q waves were present in 87%. Angioplasty was performed with PEP in 15 and without in 16. Left ventricular (LV) volumes and ejection fraction were similar (EF 46.9% vs. 49.0% without PEP, P = 0.9). Although myocardial necrosis was similar (32.5 vs. 37.3% of LV, P = 0.3), PEP improved microvascular obstruction (8.7 vs. 11.2% of LV, P = 0.02) salvaged myocardium (39.6% vs. 29.6% of area at risk, P = 0.001), and the peri-infarct region (20.9 vs. 29.6% of infarct, P < 0.0001). On multivariate analysis, the use of PEP was an independent predictor of decreased arrythmogenic peri-infarct region and greater myocardial salvage. Conclusion: In this pilot study, PEP improved myocardial salvage and the arrythmogenic peri-infarct region in late-presentation STEMI. Randomized trials are required to assess the clinical impact of improving salvaged myocardium and the peri-infarct region with PEP. © 2010 Wiley-Liss, Inc.

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Volume76, Issue4

1 October 2010

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Improving myocardial salvage in late presentation acute ST-elevation myocardial infarction with proximal embolic protection^†

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Improving myocardial salvage in late presentation acute ST-elevation myocardial infarction with proximal embolic protection†

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Improving myocardial salvage in late presentation acute ST-elevation myocardial infarction with proximal embolic protection^†