Is MRI Really the Gold Standard for the Quantification of Salvage From Myocardial Infarction?

I nfarct size is the major determinant of post myocardial in- farction remodeling and heart failure 1 and ultimately of patients' prognosis. Infarct size itself is determined by the area at risk, that is, the perfusion territory of the occluded coronary artery, the duration of ischemia, the magnitude of collateral blood flow, and only to a small extent by the hemodynamic situation, notably heart rate. The only way to salvage ischemic myocardium from impending infarction is by timely reperfusion; however, reperfusion also inflicts injury on the previously ischemic myocardium and contributes to final infarct size. 5 Such reperfusion injury can be attenuated by ischemic conditioning strategies and certain drugs, which recruit part of the signal transduction of ischemic conditioning strategies, 6,7 both in experimental animal models and in patients with reperfused acute myocardial infarction. 8