BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) pre-infarction angina, pre-procedural TIMI flow and collateral flow to the myocardium supplied by the infarct related artery are suggested to be cardioprotective. We evaluated the effect of these factors on myocardial salvage index (MSI) and infarct size adjusting for area at risk in patients with STEMI treated with primary percutaneous coronary intervention. METHODS AND RESULTS: Cardiac magnetic resonance (CMR) was used to measure myocardial area at risk within 1-7 days and final infarct size 90 ± 21 days after the STEMI in 200 patients. MSI was calculated as (area-at-risk infarct size) / area-at-risk. Patients with pre-infarction angina had a median MSI of 0.80 (IQR 0.67 to 0.86) versus 0.72 (0.61 to 0.80) in those without pre-infarction angina, P = 0.004). In a regression analysis of the infarct size plotted against the area-at-risk there was a strong trend that the line for the pre-infarction angina group was below the one for the non-angina group (P = 0.05). Patients with pre-procedural TIMI flow 0/1, 2 and 3 had a median MSI of (0.69 (IQR 0.59 to 0.76), 0.78 (0.68 to 0.86) and 0.85 (0.77 to 0.91), respectively (P<0.001). Collateral flow did not change MSI (P = 0.45) nor area-at-risk (P = 0.40) and no significant difference in infarct size adjusted for area at risk (P = 0.25) was observed. CONCLUSIONS: Pre-infarction angina increases MSI in patients with STEMI supporting the theory that pre-infarction angina leads to ischemic preconditioning. As opposed to the presence of angiographically visible collateral flow to the infarct area pre-procedural TIMI flow is strongly associated with MSI.
BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) pre-infarction angina, pre-procedural TIMI flow and collateral flow to the myocardium supplied by the infarct related artery are suggested to be cardioprotective. We evaluated the effect of these factors on myocardial salvage index (MSI) and infarct size adjusting for area at risk in patients with STEMI treated with primary percutaneous coronary intervention. METHODS AND RESULTS: Cardiac magnetic resonance (CMR) was used to measure myocardial area at risk within 1-7 days and final infarct size 90 ± 21 days after the STEMI in 200 patients. MSI was calculated as (area-at-risk infarct size) / area-at-risk. Patients with pre-infarction angina had a median MSI of 0.80 (IQR 0.67 to 0.86) versus 0.72 (0.61 to 0.80) in those without pre-infarction angina, P = 0.004). In a regression analysis of the infarct size plotted against the area-at-risk there was a strong trend that the line for the pre-infarction angina group was below the one for the non-angina group (P = 0.05). Patients with pre-procedural TIMI flow 0/1, 2 and 3 had a median MSI of (0.69 (IQR 0.59 to 0.76), 0.78 (0.68 to 0.86) and 0.85 (0.77 to 0.91), respectively (P<0.001). Collateral flow did not change MSI (P = 0.45) nor area-at-risk (P = 0.40) and no significant difference in infarct size adjusted for area at risk (P = 0.25) was observed. CONCLUSIONS: Pre-infarction angina increases MSI in patients with STEMI supporting the theory that pre-infarction angina leads to ischemic preconditioning. As opposed to the presence of angiographically visible collateral flow to the infarct area pre-procedural TIMI flow is strongly associated with MSI.
Authors: Kasper Pryds; Morten Bøttcher; Astrid Drivsholm Sloth; Kim Munk; Michael Rahbek Schmidt; Hans Erik Bøtker Journal: BMJ Open Date: 2016-11-24 Impact factor: 2.692
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Authors: Divan Gabriel Topal; Kiril Aleksov Ahtarovski; Jacob Lønborg; Dan Høfsten; Lars Nepper-Christensen; Kasper Kyhl; Mikkel Schoos; Adam Ali Ghotbi; Christoffer Göransson; Litten Bertelsen; Lene Holmvang; Steffen Helqvist; Frants Pedersen; Renate Schnabel; Lars Køber; Henning Kelbæk; Niels Vejlstrup; Thomas Engstrøm; Peter Clemmensen Journal: Int J Cardiol Heart Vasc Date: 2021-03-02
Authors: Marie Vognstoft Hjortbak; Johanne Hjort; Jonas Agerlund Povlsen; Rebekka Vibjerg Jensen; Nicolaj Brejnholdt Støttrup; Mia R Laursen; Nichlas Riise Jespersen; Bo Løfgren; Hans Erik Bøtker Journal: PLoS One Date: 2018-02-23 Impact factor: 3.240
Authors: Rehana K Leak; Edward J Calabrese; Walter J Kozumbo; Jeffrey M Gidday; Thomas E Johnson; James R Mitchell; C Keith Ozaki; Reinhard Wetzker; Aalt Bast; Regina G Belz; Hans E Bøtker; Sebastian Koch; Mark P Mattson; Roger P Simon; Randy L Jirtle; Melvin E Andersen Journal: Dose Response Date: 2018-08-15 Impact factor: 2.658