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Schaaf, Mathieu Julien, MD; Mewton, Nathan, MD, PhD; Rioufol, Gilles, MD, PhD; Angoulvant, Denis, MD, PhD; Cayla, Guillaume, MD, PhD; Delarche, Nicolas, MD; Jouve, Bernard, MD; Guerin, Patrice, MD, PhD; Vanzetto, Gerald, MD, PhD; Coste, Pierre, MD, PhD; Morel, Olivier, MD, PhD; Roubille, François, MD, PhD; Elbaz, Meyer, MD, PhD; Roth, Olivier, MD; Prunier, Fabrice, MD, PhD; Cung, Thien Tri, MD; Piot, Christophe, MD, PhD; Sanchez, Ingrid, MD; Bonnefoy-Cudraz, Eric, MD, PhD; Revel, Didier, MD; Giraud, Céline, MSc; Croisille, Pierre, MD, PhD; Ovize, Michel, MD, PhD
Journal of cardiology, 03/2016, Letnik: 67, Številka: 3Journal Article
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 72 h 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 ± 17 g vs. 21 ± 17 g, 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.
