Ischemia From Nonculprit Stenoses Is Not Associated With Reduced Culprit Infarct Size in Patients with
Kathrine Ekström1, Julie V W Nielsen1, Lars Nepper-Christensen1
1Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (K.E., J.V.W.N., L.N.-C., K.A.A., K.K., C.G., L.B., A.A.G., D.E.H., L.K., M.M.S., N.V., J.L., T.E.).
Insights
Multivessel disease in ST-segment-elevation myocardial infarction (STEMI) patients does not affect final infarct size or myocardial salvage. This finding helps refine future cardioprotective treatment studies in STEMI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Reperfusion injury significantly impacts infarct size and prognosis in STEMI patients treated with primary PCI.
- Remote ischemic preconditioning in nonculprit arteries may protect myocardium, with positive FFR indicating functional significance.
Purpose of the Study:
- To investigate the association between functional significant multivessel disease (MVD) and reduced infarct size or increased myocardial salvage index (MSI) in STEMI patients.
Main Methods:
- 610 STEMI patients underwent cardiac MRI post-primary PCI.
- Patients were stratified by FFR in nonculprit stenosis: single vessel disease (SVD), functional SVD, or functional MVD.
Main Results:
- No significant difference in final infarct size or MSI was observed across SVD, functional SVD, and functional MVD groups.
- Multivariable analyses confirmed functional MVD was not associated with increased MSI or reduced infarct size.
Conclusions:
- Functional MVD in nonculprit myocardium does not reduce infarct size or increase MSI in STEMI patients.
- This knowledge excludes functional MVD as a confounding factor in future cardioprotective treatment studies for STEMI.
Background:
In patients with ST-segment-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention, reperfusion injury accounts for a significant fraction of the final infarct size, which is directly related to patient prognosis. In animal studies, brief periods of ischemia in noninfarct-related (nonculprit) coronary arteries protect the culprit myocardium via remote ischemic preconditioning. Positive fractional flow reserve (FFR) documents functional significant coronary nonculprit stenosis, which may offer remote ischemic preconditioning of the culprit myocardium. The aim of the study was to investigate the association between functional significant, multivessel disease (MVD) and reduced culprit final infarct size or increased myocardial salvage (myocardial salvage index [MSI]) in a large contemporary cohort of STEMI patients.
Methods:
Cardiac magnetic resonance was performed in 610 patients with STEMI at day 1 and 3 months after primary percutaneous coronary intervention. Patients were stratified into 3 groups according to FFR measurements in nonculprit stenosis (if any): angiographic single vessel disease (SVD), FFR nonsignificant MVD (functional SVD), or FFR-significant, functional MVD.
Results:
A total of 431 (71%) patients had SVD, 35 (6%) had functional SVD, and 144 (23%) had functional MVD. There was no difference in final infarct size (mean infarct size [%left ventricular mass] SVD, 9±3%; functional SVD, 9±3%; and functional MVD, 9±3% [P=0.82]) or in MSI between groups (mean MSI [%left] SVD, 66±23%; functional SVD, 68±19%; and functional MVD, 69±19% [P=0.62]). In multivariable analyses, functional MVD was not associated with larger MSI (P=0.56) or smaller infarct size (P=0.55).
Conclusions:
Functional MVD in nonculprit myocardium was not associated with reduced culprit final infarct size or increased MSI following STEMI. This is important knowledge for future studies examining a cardioprotective treatment in patients with STEMI, as a possible confounding effect of FFR-significant, functional MVD can be discarded. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER) and NCT01960933 (DANAMI 3-PRIMULTI).
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