April 8, 2009European Heart Journal104 citations

Infarct size and myocardial salvage after primary angioplasty in patients presenting with symptoms for <12 h vs. 12-72 h

MBMartin BuskInterventional Cardiology AKAnne KaltoftShanghai Jiao Tong University SNSøren Saxmose NielsenUniversity of Copenhagen

Structured PICO

Does primary angioplasty provide myocardial salvage in STEMI patients presenting late (12-72 h) compared to early presenters (<12 h)?

Population

396 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty, including early presenters (<12 h symptom duration, n=341) and late presenters (12-72 h symptom duration, n=55).

Intervention

Primary angioplasty in late presenters (12-72 h symptom duration)

Comparator

Primary angioplasty in early presenters (<12 h symptom duration)

Outcome

Final infarct size (FIS, % of LV myocardium) and myocardial salvage index (% non-infarcted area at risk) assessed by myocardial perfusion imaging at 30 dayssurrogate

Primary angioplasty in STEMI patients presenting between 12-72 hours yields substantial myocardial salvage, suggesting potential benefit beyond the traditional 12-hour window.

Abstract

AIMS: Primary angioplasty for ST-segment elevation myocardial infarction (STEMI) is recommended only if symptom duration is 50% of AAR) was observed in 41% of late presenters despite total infarct-artery occlusion. CONCLUSION: FIS is larger in late presenters (>12 h) than early presenters after primary angioplasty for STEMI. However, substantial myocardial salvage can be obtained beyond the 12 h limit, even when the infarct-related artery is totally occluded.

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