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Time-dependent detrimental effects of distal embolization on myocardium and microvasculature during primary
Massimo Napodano1, Diletta Peluso, Martina Perazzolo Marra
1Laboratory of Epidemiological Methods and Biostatistics, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy. massimo.napodano@gmail.com
Insights
Distal embolization during primary percutaneous coronary intervention significantly increases myocardial damage and necrosis, especially within the first three hours of symptom onset. After three hours, the impact of distal embolization on heart damage is limited.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Distal embolization (DE) during primary percutaneous coronary intervention (p-PCI) is associated with increased myocardial necrosis and worsened microvascular perfusion.
- Limited data exist on the specific impact of DE on jeopardized myocardium, including necrosis extent and distribution.
Purpose of the Study:
- To investigate the impact of distal embolization (DE) on myocardial damage and microvascular reperfusion.
- To analyze the influence of time-to-treatment on the effects of DE using contrast-enhanced cardiac magnetic resonance (CE-CMR).
Main Methods:
- Prospective assessment of 288 patients undergoing p-PCI within 6 hours of symptom onset.
- Utilized CE-CMR to evaluate infarct size and microvascular damage.
- Compared outcomes between patients with and without DE, stratified by time-to-treatment (<3 hours vs. ≥3 to ≤6 hours).
Main Results:
- DE occurred in 14.3% of patients, with no difference in baseline characteristics.
- Patients with DE showed larger infarct size and more transmural necrosis when treated within 3 hours (p=0.038, p=0.008).
- DE was associated with more frequent microvascular obstruction (100% vs. 66.5%, p=0.001) up to 6 hours, but no significant impact on necrosis was observed after 3 hours.
Conclusions:
- The detrimental effect of DE on myocardial damage is significantly influenced by ischemic time.
- DE increases necrosis extent in patients treated within the first 3 hours of symptom onset.
- The impact of DE on myocardial damage is limited or absent after the 3-hour time window.
Objectives:
The authors sought to investigate the impact of distal embolization (DE) on myocardial damage and microvascular reperfusion, according to time-to-treatment, using contrast-enhanced cardiac magnetic resonance (CE-CMR).
Background:
DE, occurring during primary percutaneous coronary intervention (p-PCI), appears to increase myocardial necrosis and to worsen microvascular perfusion, as shown by surrogate markers. However, data regarding the behavior of DE on jeopardized myocardium, and in particular on necrosis extent and distribution, are still lacking.
Methods:
In 288 patients who underwent p-PCI within 6 h from symptom onset, the authors prospectively assessed the impact of DE on infarct size and microvascular damage, using CE-CMR. The impact of DE was assessed according to time-to-treatment: for group 1, <3 h; for group 2, ≥3 and ≤6 h.
Results:
DE occurred in 41 (14.3%) patients. Baseline clinical characteristics were not different between the 2 groups. At CE-CMR, patients with DE showed larger infarct size (p = 0.038) and more often transmural necrosis compared with patients without DE (p = 0.008) when time-to-treatment was <3 h, but no impact was proven after this time (p = NS). Patients with DE showed more often microvascular obstruction, as evaluated at first-pass enhancement, than patients without DE (100% vs. 66.5%, p = 0.001) up to 6 h from symptom onset.
Conclusions:
These findings suggest that the detrimental impact of DE occurring during p-PCI on myocardial damage is largely influenced by ischemic time, increasing the extent of necrosis in patients presenting within the first hours after symptom onset, and having limited or no impact after this time window.
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