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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Improving myocardial salvage in late presentation acute ST-elevation myocardial infarction with proximal embolic
Eric Larose1, Helena Tizon-Marcos, Josep Rodés-Cabau
1Cardiac Catheterization Laboratories, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval, Québec, Canada. Eric.Larose@criucpq.ulaval.ca
Insights
Proximal embolic protection (PEP) significantly improved myocardial salvage and reduced the arrhythmogenic peri-infarct region in late-presenting ST-elevation myocardial infarction (STEMI) patients. Further randomized trials are needed to confirm the clinical impact of PEP in STEMI treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Late-presenting ST-elevation myocardial infarction (STEMI) is associated with larger thrombi, leading to adverse ventricular remodeling and arrhythmias.
- Current angioplasty and pharmacological therapies have limitations in mitigating these negative outcomes in late STEMI.
- Proximal embolic protection (PEP) was investigated as a potential strategy to reduce myocardial injury in this patient group.
Purpose of the Study:
- To evaluate the efficacy of proximal embolic protection (PEP) in reducing myocardial injury in patients presenting with STEMI between 12-24 hours after symptom onset.
- To assess the impact of PEP on myocardial function, area at risk, necrosis, salvaged myocardium, and the arrhythmogenic peri-infarct region.
Main Methods:
- A cohort study involving 31 patients with first STEMI (12-24 hours onset, TIMI 0-1 flow) treated with or without PEP.
- Patients were matched for age, gender, and infarct-related artery.
- Contrast-enhanced magnetic resonance imaging (CE-MRI) was used to quantify myocardial damage and function, with clinical follow-up.
Main Results:
- While overall left ventricular volumes and ejection fraction were similar between groups, PEP significantly improved microvascular obstruction (P=0.02).
- PEP demonstrated a significant increase in salvaged myocardium (39.6% vs. 29.6%, P=0.001) and a reduction in the arrhythmogenic peri-infarct region (20.9% vs. 29.6%, P<0.0001).
- Multivariate analysis identified PEP as an independent predictor of decreased arrhythmogenic peri-infarct region and greater myocardial salvage.
Conclusions:
- This pilot study suggests that proximal embolic protection (PEP) can improve myocardial salvage and reduce the arrhythmogenic peri-infarct region in late-presentation STEMI.
- The findings indicate a potential benefit of PEP in mitigating adverse cardiac remodeling and arrhythmia risk.
- Randomized trials are warranted to validate these results and assess the clinical significance of PEP in managing late STEMI.
Background:
Late-presenting ST-elevation myocardial infarction (STEMI) patients possess larger, more organized coronary thrombus leading to greater ventricular remodeling and arrhythmia despite angioplasty and pharmacological therapies. We hypothesized that myocardial injury would be reduced in late STEMI by proximal embolic protection (PEP).
Methods:
31 patients with first STEMI 12-24 hr after pain onset and TIMI 0-1 flow were treated with or without PEP (cohort design matched for age, gender, and infarct-related artery). Contrast-enhanced magnetic resonance determined myocardial function, area at risk, necrosis, salvaged myocardium, and arrythmogenic peri-infarct region. Clinical follow-up was performed.
Results:
Pain to balloon time was 18 hr (95% CI 15.5-21.2 h), and Q waves were present in 87%. Angioplasty was performed with PEP in 15 and without in 16. Left ventricular (LV) volumes and ejection fraction were similar (EF 46.9% vs. 49.0% without PEP, P = 0.9). Although myocardial necrosis was similar (32.5 vs. 37.3% of LV, P = 0.3), PEP improved microvascular obstruction (8.7 vs. 11.2% of LV, P = 0.02) salvaged myocardium (39.6% vs. 29.6% of area at risk, P = 0.001), and the peri-infarct region (20.9 vs. 29.6% of infarct, P < 0.0001). On multivariate analysis, the use of PEP was an independent predictor of decreased arrythmogenic peri-infarct region and greater myocardial salvage.
Conclusion:
In this pilot study, PEP improved myocardial salvage and the arrythmogenic peri-infarct region in late-presentation STEMI. Randomized trials are required to assess the clinical impact of improving salvaged myocardium and the peri-infarct region with PEP.
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