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Time-dependent detrimental effects of distal embolization on myocardium and microvasculature during primary percutaneous coronary intervention.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2012 Nov; Vol. 5 (11), pp. 1170-7. - Publication Year :
- 2012
-
Abstract
- Objectives: The authors sought to investigate the impact of distal embolization (DE) on myocardial damage and microvascular reperfusion, according to time-to-treatment, using contrast-enhanced cardiac magnetic resonance (CE-CMR).<br />Background: DE, occurring during primary percutaneous coronary intervention (p-PCI), appears to increase myocardial necrosis and to worsen microvascular perfusion, as shown by surrogate markers. However, data regarding the behavior of DE on jeopardized myocardium, and in particular on necrosis extent and distribution, are still lacking.<br />Methods: In 288 patients who underwent p-PCI within 6 h from symptom onset, the authors prospectively assessed the impact of DE on infarct size and microvascular damage, using CE-CMR. The impact of DE was assessed according to time-to-treatment: for group 1, <3 h; for group 2, ≥3 and ≤6 h.<br />Results: DE occurred in 41 (14.3%) patients. Baseline clinical characteristics were not different between the 2 groups. At CE-CMR, patients with DE showed larger infarct size (p = 0.038) and more often transmural necrosis compared with patients without DE (p = 0.008) when time-to-treatment was <3 h, but no impact was proven after this time (p = NS). Patients with DE showed more often microvascular obstruction, as evaluated at first-pass enhancement, than patients without DE (100% vs. 66.5%, p = 0.001) up to 6 h from symptom onset.<br />Conclusions: These findings suggest that the detrimental impact of DE occurring during p-PCI on myocardial damage is largely influenced by ischemic time, increasing the extent of necrosis in patients presenting within the first hours after symptom onset, and having limited or no impact after this time window.<br /> (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Female
Humans
Male
Microvessels
Middle Aged
Necrosis etiology
Prospective Studies
Time Factors
Cardiomyopathies etiology
Embolism complications
Intraoperative Complications etiology
Myocardial Infarction surgery
Myocardium pathology
Percutaneous Coronary Intervention
Vascular Diseases etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 5
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 23174642
- Full Text :
- https://doi.org/10.1016/j.jcin.2012.06.022