BACKGROUND: The TIMI myocardial perfusion grade (TMPG) and ST-segment resolution both reflect perfusion and are associated with mortality after thrombolysis for acute myocardial infarction. We hypothesized that these measures would also be associated with infarct size by single photon emission computed tomography (SPECT). Methods and Results- In the LIMIT AMI trial (Limitation of Myocardial Injury following Thrombolysis in Acute Myocardial Infarction) of lytic monotherapy versus lytic plus rhuMAb CD18, early 90-minute TMPG (n=221) and ST segment resolution (n=242) were compared with subsequent SPECT Technetium-99 m Sestamibi, measuring the percentage of the left ventricle with no Sestamibi uptake. Infarct sizes were larger with TMPG 0 or 1 (a closed or stained myocardium) than with TMPG 2 or 3 (open myocardium, median 13% versus 7%, P=0.004). Infarcts were also larger in patients with no ST segment resolution (median 15%) or incomplete resolution (11%) than in those with complete resolution (6%, overall P=0.0001). The difference in infarct size by TMPG persisted when stratified by category of ST resolution. CONCLUSIONS: There may be a pathophysiological link between early restoration of tissue-level perfusion and reduced subsequent infarct size that may partially explain why these early angiographic and electrocardiographic measures are associated with long-term survival.
BACKGROUND: The TIMI myocardial perfusion grade (TMPG) and ST-segment resolution both reflect perfusion and are associated with mortality after thrombolysis for acute myocardial infarction. We hypothesized that these measures would also be associated with infarct size by single photon emission computed tomography (SPECT). Methods and Results- In the LIMIT AMI trial (Limitation of Myocardial Injury following Thrombolysis in Acute Myocardial Infarction) of lytic monotherapy versus lytic plus rhuMAb CD18, early 90-minute TMPG (n=221) and ST segment resolution (n=242) were compared with subsequent SPECT Technetium-99 m Sestamibi, measuring the percentage of the left ventricle with no Sestamibi uptake. Infarct sizes were larger with TMPG 0 or 1 (a closed or stained myocardium) than with TMPG 2 or 3 (open myocardium, median 13% versus 7%, P=0.004). Infarcts were also larger in patients with no ST segment resolution (median 15%) or incomplete resolution (11%) than in those with complete resolution (6%, overall P=0.0001). The difference in infarct size by TMPG persisted when stratified by category of ST resolution. CONCLUSIONS: There may be a pathophysiological link between early restoration of tissue-level perfusion and reduced subsequent infarct size that may partially explain why these early angiographic and electrocardiographic measures are associated with long-term survival.
Authors: Arshed A Quyyumi; Alejandro Vasquez; Dean J Kereiakes; Marc Klapholz; Gary L Schaer; Ahmed Abdel-Latif; Stephen Frohwein; Timothy D Henry; Richard A Schatz; Nabil Dib; Catalin Toma; Charles J Davidson; Gregory W Barsness; David M Shavelle; Martin Cohen; Joseph Poole; Thomas Moss; Pamela Hyde; Anna Maria Kanakaraj; Vitaly Druker; Amy Chung; Candice Junge; Robert A Preti; Robin L Smith; David J Mazzo; Andrew Pecora; Douglas W Losordo Journal: Circ Res Date: 2016-11-07 Impact factor: 17.367
Authors: Ajay J Kirtane; Anh Bui; Sabina A Murphy; Dimitrios Karmpaliotis; Ioanna Kosmidou; Keith Boundy; Aref Rahman; Duane S Pinto; Julian M Aroesty; Robert P Giugliano; Christopher P Cannon; Elliott M Antman; C Michael Gibson Journal: J Thromb Thrombolysis Date: 2004-06 Impact factor: 2.300