Key result
Delayed myocardial perfusion improves after primary PCI, rising from 41% immediately post-procedure to 61% at one week.
Why the study?
The evolution of TIMI myocardial perfusion grade within the first week after primary PCI and its association with ST-segment resolution and LV function recovery was not well characterized.
Observational (n=76)
Absolute Event Rate: 61% vs 41%
p-value: p=0.003
Myocardial perfusion continues to improve dynamically within the first week after primary PCI for acute myocardial infarction, an improvement that is predicted by early ST-segment resolution.
TMPG evolution after primary PCI may aid LV recovery risk stratification; leaves open whether serial assessment improves outcomes over standard care.
BACKGROUND: Myocardial perfusion at the end of reperfusion therapy assessed angiographically with thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG) has been associated with recovery of left ventricular (LV) function and survival. The aim of this analysis was to study the evolution of TMPG within the first week following primary percutaneous coronary intervention (PCI) and its association with ECG-derived ST-segment resolution (STRES) and recovery of LV function. METHODS: A total of 76 patients with acute myocardial infarction were pretreated with enoxaparine and abciximab and subjected to primary PCI within a prospective study and evaluated with TMPG assessed on coronary angiography at the end of the procedure and after 5-7 days. STRES was evaluated at 120 min post inclusion and global LV function was assessed by echocardiography after 30 days. RESULTS: Reperfusion (TIMI flow 2-3) was reached in all patients. Forty one percent had 'open myocardium' (i.e. TMPG 2 or 3) after PCI, a number that increased to 61% after 5-7 days (P=0.003). STRES >50% was reached in 73% of the patients and there was a good correlation between TMPG and STRES. Furthermore, those who improved from 'closed' to 'open myocardium' had higher STRES (and similar to those with 'open myocardium' already post-PCI) than those who had 'closed myocardium' at both occasions (80 vs. 52%, P=0.012). CONCLUSION: A significant increase was found in the number of patients with 'open myocardium' within the first week post-primary PCI and STRES seems to predict this improvement.
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Aasa et al. (2007) conducted an observational in acute myocardial infarction (n=76). Time post-primary PCI vs. Immediate post-PCI was evaluated on Proportion of patients with 'open myocardium' (TMPG 2 or 3) (p=0.003). The proportion of patients with 'open myocardium' increased significantly from 41% immediately after primary PCI to 61% at 5-7 days (P=0.003).
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