What are the key findings of this study?

Primary PTCA treatment delay of 3 hours (+21% vs +8% and +6%, P<0.02).

What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction (n=40). Intervention: Primary PTCA delay 3 hours (3-6 hours, 6-12 hours, >12 hours). Primary outcome: Improvement of regional left ventricular function (segmental wall thickening) (p=<0.02).

January 22, 2009Open Access

Quantification of regional functional improvement of infarcted myocardium after primary PTCA by contrast‐enhanced magnetic resonance imaging

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute myocardial infarction (n=40). Intervention: Primary PTCA delay 3 hours (3-6 hours, 6-12 hours, >12 hours). Primary outcome: Improvement of regional left ventricular function (segmental wall thickening) (p=<0.02).

Q: What does this research mean for the field?

Primary percutaneous transluminal coronary angioplasty (PTCA) treatment delays of less than 3 hours significantly improve regional functional recovery of infarcted myocardium at 4 months compared to delays greater than 3 hours. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Primary PTCA treatment delay of <3 hours significantly improved regional functional recovery of infarcted myocardium at 4 months compared to delays >3 hours (+21% vs +8% and +6%, P<0.02).

Study Design

Type

Observational (n=40)

Structured PICO

Does the time to primary PTCA treatment influence regional functional recovery of infarcted myocardium in patients with first AMI?

Population

40 patients with first acute myocardial infarction (AMI) after restoring TIMI 3 flow with primary percutaneous transluminal coronary angioplasty (p-PTCA)

Intervention

Primary PTCA with different treatment delays (<3 hours, 3-6 hours, 6-12 hours, and >12 hours)

Comparator

Comparison between different treatment delay groups

Outcome

Improvement of regional left ventricular function (segmental wall thickening) assessed by cardiac magnetic resonance imaging at 4 months follow-upsurrogate

Early reperfusion (<3 hours) by primary PTCA significantly improves regional functional recovery of infarcted myocardium at 4 months as assessed by CMR.

Main Result

p-value: p=<0.02

Abstract

PURPOSE: To assess with cardiac magnetic resonance imaging (CMR) the relationship between treatment delay and improvement of regional left ventricular function after primary percutaneous transluminal coronary angioplasty (p-PTCA) for acute myocardial infarction (AMI). MATERIALS AND METHODS: We performed cine- and late-enhancement (LE) CMR in 40 patients with first AMI after restoring TIMI 3 flow with p-PTCA and at a follow-up 4 months later. Infarcted segments were determined from LE images. Regional left ventricular function was quantified from cine-CMR images. Segmentation followed the American Heart Association 17-segments model. Patients were divided into groups with delay 12 hours. RESULTS: Segmental wall thickening (SWT) significantly iproved only in segments reperfused within 6 hours (P 3 hours (<3 hours: +21 +/- 3%, 3-6 hours: +8 +/- 4%, 6-12 hours: +6 +/- 3%; <3 hours to 3-6 hours, and 6-12 h, P < 0.02). CONCLUSION: We quantitatively demonstrated that time to p-PTCA treatment significantly influences regional functional recovery of infarcted myocardium at a 4-month follow-up.

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