Yama Fakhri1, Martin Busk2, Mikkel Malby Schoos3, Christian Juhl Terkelsen4, Steen D Kristensen5, Galen S Wagner6, Maria Sejersten7, Peter Clemmensen8, Jens Kastrup7. 1. Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark; Department of Medicine, Division of Cardiology, Nykøbing F University Hospital, Nykøbing F, Denmark. Electronic address: yfakhri@gmail.com. 2. Department of Cardiology, Vejle Hospital, Vejle, Denmark. 3. Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark. 4. Zealand University Hospital, Denmark. 5. Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. 6. Department of Medicine, Duke University Medical Center, Durham, NC, USA. 7. Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark. 8. Department of Medicine, Division of Cardiology, Nykøbing F University Hospital, Nykøbing F, Denmark; Department of Medicine, Division of Cardiology, Nykøbing F Hospital, Nykøbing F and University of Southern Denmark, Odense, Denmark; University Clinic Hamburg-Eppendorf, The Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany.
Abstract
BACKGROUND: Primary percutaneous coronary intervention (pPCI) is recommended in patients with ST Elevation Myocardial Infarction (STEMI) and symptom duration <12hours. However, a considerable amount of myocardium might still be salvaged in STEMI patients with symptom durations >12hours (late-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters. METHODS: The AW-score (range 1-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage potential (MSI) according to AW-score ≥3 (acute ischemia) and AW-score <3 (late ischemia). RESULTS: Late-presenters had median MSI 53% (inter quartile range (IQR) 27-89). The AW-score strongly correlated with MSI (β=0.60, R(2)=0.36, p<0.0001), while pain-to-balloon time did not (β=-0.21, R(2)=0.04, p=0.14). Patients with AW-score ≥3 (n=16) compared to those with AW-score <3 (n=27) had significant larger MSI (82.7% vs 41.5%, p=0.014). MSI>median was observed in 79% in patients with AW-score ≥3 vs 32% in patients with AW-score <3 (adjusted OR 6.74 [95% CI 1.35-33.69], p=0.02). CONCLUSION: AW-score was strongly associated with myocardial salvage while pain-to-balloon time was not. STEMI patients with symptom duration between 12 -72hours and AW-score ≥3 achieved substantial salvage after pPCI.
BACKGROUND: Primary percutaneous coronary intervention (pPCI) is recommended in patients with ST Elevation Myocardial Infarction (STEMI) and symptom duration <12hours. However, a considerable amount of myocardium might still be salvaged in STEMI patients with symptom durations >12hours (late-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters. METHODS: The AW-score (range 1-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage potential (MSI) according to AW-score ≥3 (acute ischemia) and AW-score <3 (late ischemia). RESULTS: Late-presenters had median MSI 53% (inter quartile range (IQR) 27-89). The AW-score strongly correlated with MSI (β=0.60, R(2)=0.36, p<0.0001), while pain-to-balloon time did not (β=-0.21, R(2)=0.04, p=0.14). Patients with AW-score ≥3 (n=16) compared to those with AW-score <3 (n=27) had significant larger MSI (82.7% vs 41.5%, p=0.014). MSI>median was observed in 79% in patients with AW-score ≥3 vs 32% in patients with AW-score <3 (adjusted OR 6.74 [95% CI 1.35-33.69], p=0.02). CONCLUSION: AW-score was strongly associated with myocardial salvage while pain-to-balloon time was not. STEMI patients with symptom duration between 12 -72hours and AW-score ≥3 achieved substantial salvage after pPCI.
Authors: Adam Ali Ghotbi; Andreas Kjaer; Lars Nepper-Christensen; Kiril Aleksov Ahtarovski; Jacob Thomsen Lønborg; Niels Vejlstrup; Kasper Kyhl; Thomas Emil Christensen; Thomas Engstrøm; Henning Kelbæk; Lene Holmvang; Lia E Bang; Rasmus Sejersten Ripa; Philip Hasbak Journal: J Nucl Cardiol Date: 2016-10-14 Impact factor: 5.952
Authors: Adam Ali Ghotbi; Philip Hasbak; Lars Nepper-Christensen; Jacob Lønborg; Kiril Atharovski; Thomas Christensen; Lene Holmvang; Thomas Engstrøm; Rasmus Sejersten Ripa; Andreas Kjær Journal: J Nucl Cardiol Date: 2017-07-17 Impact factor: 5.952