Mathieu Julien Schaaf1, Nathan Mewton2, Gilles Rioufol3, Denis Angoulvant4, Guillaume Cayla5, Nicolas Delarche6, Bernard Jouve7, Patrice Guerin8, Gerald Vanzetto9, Pierre Coste10, Olivier Morel11, François Roubille12, Meyer Elbaz13, Olivier Roth14, Fabrice Prunier15, Thien Tri Cung12, Christophe Piot12, Ingrid Sanchez3, Eric Bonnefoy-Cudraz3, Didier Revel16, Céline Giraud3, Pierre Croisille17, Michel Ovize2. 1. Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France. Electronic address: Mathieu.schaaf@gmail.com. 2. Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France; INSERM UMR-1060, CarMeN Laboratory, Université Claude Bernard Lyon1, Faculté de Médecine Lyon Est, F-69373 Lyon, France. 3. Cardiology Division, Centre d'Investigation Clinique de Lyon (CIC), Groupement Hospitalier Est, Hôpital Louis Pradel, 28 avenue Doyen Lépine, 69677 Bron, Hospices Civils de Lyon, France. 4. University Hospital of Tours, Hopital Trousseau, Cardiology Division, Université François Rabelais, Tours, France. 5. University Hospital of Nîmes, Hôpital Universitaire Carémeau, Cardiology Division, Nîmes, France. 6. Regional Hospital of Pau, Cardiology Division, Pau, France. 7. Regional Hospital of Aix-en-Provence, Cardiology Division, Aix en Provence, France. 8. Thorax Institute, Invasive Cardiology Department, University Hospital of Nantes, Nantes, France. 9. University Hospital of Grenoble, Hôpital La Tronche, Cardiology Division, Grenoble, France. 10. University Hospital of Bordeaux, Groupe Hospitalier Sud Pessac, Bordeaux, France. 11. University Hospital of Strasbourg, Nouvel Hôpital Civil, Cardiology Division, Strasbourg, France. 12. University Hospital of Montpellier, Cardiology Division, UMR5203, UMR661, Universités Montpellier 1 and 2, Montpellier, France. 13. University Hospital of Toulouse, Hôpital Rangeuil, Université Paul Sabatier, Toulouse, France. 14. Regional Hospital of Mulhouse, Hôpital Emile Müller, Cardiology Division, Mulhouse, France. 15. University Hospital of Angers, Cardiology Division, Angers, France. 16. Radiology Department, CREATIS-LRMN, CNRS UMR 5220 - INSERM U630 - Université Claude Bernard Lyon 1, Lyon, France. 17. Radiology Department, CREATIS-LRMN, CNRS UMR 5220 - INSERM U630 - Université Claude Bernard Lyon 1, Lyon, France; University Hospital of Saint-Etienne, Radiology Department, Saint-Etienne, France.
Abstract
OBJECTIVE: The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). METHODS: In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72h after admission. RESULTS: A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95±0.02 vs. 2.97±0.02, respectively; p=0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32±17g vs. 21±17g, respectively; p=0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p=0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. CONCLUSION: Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.
OBJECTIVE: The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). METHODS: In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72h after admission. RESULTS: A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95±0.02 vs. 2.97±0.02, respectively; p=0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32±17g vs. 21±17g, respectively; p=0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p=0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. CONCLUSION: Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.
Authors: Hans-Josef Feistritzer; Sebastian Johannes Reinstadler; Gert Klug; Martin Reindl; Sebastian Wöhrer; Christoph Brenner; Agnes Mayr; Johannes Mair; Bernhard Metzler Journal: BMC Cardiovasc Disord Date: 2016-11-28 Impact factor: 2.298
Authors: Mohaned Egred; Alan Bagnall; Ioakim Spyridopoulos; Ian F Purcell; Rajiv Das; Nick Palmer; Ever D Grech; Ajay Jain; Gregg W Stone; Robin Nijveldt; Thomas McAndrew; Azfar Zaman Journal: Int J Cardiol Heart Vasc Date: 2020-05-15