Determinants of infarct mass, assessed by cardiac magnetic resonance, in STEACS revascularized by primary-PCI: findings of the PROMISE randomized clinical trial
| Autor: | H. Gutierrez, David Garcia-Dorado, José A. Barrabés, S. Moral, Gerard Martí, I Ferreira Gonzalez, Eva Raga Domingo, Jaime Elízaga, Imanol Otaegui, B. Garcia-Del-Blanco |
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| Rok vydání: | 2013 |
| Předmět: |
medicine.diagnostic_test
business.industry medicine.medical_treatment Percutaneous coronary intervention Magnetic resonance imaging Placebo law.invention Reperfusion therapy Randomized controlled trial law Conventional PCI medicine Cardiology and Cardiovascular Medicine business Nuclear medicine Body mass index TIMI |
| Zdroj: | European Heart Journal. 34:P471-P471 |
| ISSN: | 1522-9645 0195-668X |
| Popis: | Objective: The randomized, placebo controlled, PROMISE trial assessed the effect of intracoronary adenosine given at the time of primary percutaneous coronary intervention (PCI). Determinants of relative infarct mass (RIM), assessed by magnetic resonance imaging (MRI), are presented. Methods and results: 177 patients with a first STEMI receiving PCI within 6 hours of symptoms onset (SO) who underwent MRI 2-7 days after reperfusion were included. RIM, the percentage of total myocardial mass necrosed, was quantified by late Gadolinium enhancement. Myocardium at risk (MAR), quantified by T2 weighted sequences, demographics, risk factors, angiographic characteristics, reperfusion time, and intra-procedure features were potential determinants of RIM to be assessed by linear regression modeling. TIMI 3 flow was achieved in 162 (91.5%) patients a mean of 211 minutes (SD: 64.17, IQR: 105 - 195) after SO. Grade 2-3 Rentrop collateral flow was present in 38 (21.5%) patients. Percentage of total MAR was 35% (SD13%; min 12%, max 78%), and the final RIM was 21.6% (SD13.1%; min 0%, max 53.3%; mean salvaged myocardium 38%). The best model (Table) predicted 70.6% of the total variability of RIM. MAR had the most impact on final RIM, whereas the impact of the rest was modest. Rentrop 2-3 did not predict lower RIM but it attenuated the effect of MAR on the final RIM (significant interaction). Higher body mass index (BMI) was associated with lower RIM. View this table: Table 1. Predictors Conclusion: More than 50% of MAR, the variable with the highest impact on final RIM, is not salvaged in spite of the best available treatments. The low impact of time OS-TIMI III flow in final RIM probably reflects that most patients arrive too late to influence RIM substantially. A paradoxical relationship between BMI and RIM was found. |
| Databáze: | OpenAIRE |
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