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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Primary percutaneous coronary intervention in ST-elevation myocardial infarction with an ectatic infarct-related
Batric Popovic1, Nelly Agrinier2, Pierre Adrien Metzdorf1
1CHU Nancy, Département de Cardiologie.
Insights
Patients with ectatic infarct-related arteries (IRA) in ST-elevation myocardial infarction show impaired blood flow and higher embolization risk. However, they paradoxically had better ejection fraction and similar long-term survival compared to controls.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring prompt reperfusion.
- The anatomy of the infarct-related artery (IRA), including ectasia, can influence treatment outcomes.
- Understanding the implications of ectatic IRA in STEMI is crucial for optimizing patient management.
Purpose of the Study:
- To investigate procedural characteristics, myocardial perfusion, and long-term outcomes in STEMI patients with an ectatic IRA.
- To compare outcomes between STEMI patients with ectatic IRA and those with normal IRA anatomy.
Main Methods:
- Retrospective analysis of 1270 STEMI patients undergoing primary percutaneous coronary intervention.
- Patients were categorized into ectatic IRA (n=91) and control (n=1179) groups.
- Comparison of procedural results, including Thrombolysis In Myocardial Infarction (TIMI) flow, distal embolization, and ST-segment resolution, along with left ventricular ejection fraction and infarct size.
Main Results:
- Ectatic IRA group had lower TIMI grade 3 flow (64.8% vs 88.2%) and more distal embolization (44.4% vs 11.1%) post-intervention.
- Significantly lower ST-segment resolution was observed in the ectatic IRA group (P<0.001).
- Paradoxically, higher left ventricular ejection fraction at discharge (P=0.032) and smaller infarct size trend (P=0.06) were noted in the ectatic group. 30-day and long-term mortality were similar between groups.
Conclusions:
- STEMI patients with ectatic IRA present with high thrombus burden and impaired microvascular function.
- Despite procedural challenges, left ventricular function may be preserved, and long-term survival is not significantly affected.
- Discrepancies between angiographic findings and functional outcomes in ectatic IRA warrant further investigation for long-term survival impact.
Objective:
The aim of this study was to describe the procedural characteristics, myocardial perfusion, and long-term outcomes in ST-elevation myocardial infarction patients with an ectatic infarct-related artery (IRA).
Patients And Methods:
The retrospective analysis included 1270 consecutive ST-elevation myocardial infarction patients treated by primary percutaneous coronary intervention who were categorized according to the coronary anatomy of the IRA as follows: ectatic group (n=91) and control group (n=1179).
Results:
Compared with the control group, patients in the ectatic group experienced lower Thombolysis in myocardial infarction grade 3 flow rate after percutaneous coronary intervention (64.8 vs. 88.2%: ectatic group vs. nonectatic group, P<0.001) and more frequent distal embolization (44.4 vs. 11.1%, P<0.001). ECG ST resolution was significantly lower in the ectatic group (P<0.001). Paradoxically, the left ventricular ejection fraction values at discharge were significantly higher in the ectatic group (P=0.032) and the infarct size assessed within 6-12 months after discharge tended to be smaller (P=0.06). The 30-day mortality rate was not significantly different between the two groups (3.3 vs. 5.0%, P=0.378) as well as Kaplan-Meier analysis for long-term overall survival in both groups (P=0.8).
Conclusion:
Patients with ectatic IRA were characterized by discrepancies between high angiographic thrombus burden in a larger vessel and impact on left ventricular function that may influence their long-term survival.
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