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ȣ - 490727 221 |
| The protection device reduced infarct size measured by serial contrast enhancement MRI in primary PCIs |
| 연세대학교 의과대학 신촌세브란스병원, 심장혈관병원 심장내과¹ , 영상의학과² |
| 문재연¹, 고영국¹ , 김영진² , 박성하¹ , 최병욱¹ , 최동훈¹ , 장양수¹ , 정남식¹ , 심원흠¹ , 조승연¹ |
Background:The areas of infarction can now be defined noninvasively using MRI in delayed hyperenhancement. Therefore, we investigated the time course of infarct resorption after AMI and examined whether an occlusive balloon type distal protection device(percuSurge GuardWireR; GW) used during PCI may reduce delayed hyperenhancement size in MRI follow up. Method:Total 54 consecutive patients with AMI who underwent PCI were investigated. Patients were classified into three groups; GroupA(n=18, age 54±11): primary PCI with protection devices within 6 hours from AMI onset, GroupB(n=21, age 56±9): primary PCI without protection devices within 6 hours from onset, GroupC(n=15, age 63±13): elective PCI after the initial 6 hours of symptom onset. In all patients, gadolinium enhanced MRI was performed 3-7 days after PCI and the thirty two patients examined follow up MRI at 3-4 months. We measured the mass of infarcted myocardium and left ventricle(LV) by tracing of the hyperenhancement area and LV in delayed imaging and calculating absolute values(gram) of mass assuming a myocardial specific gravity of 1.055g/cm3. We evaluated the changes in terms of the value of infarcted mass and the infarcted mass percent(Infarcted mass/LV mass) Result:Infracted mass of initial MRI showed linear correlations with peak cardiac enzymes and initial LV ejection fraction. There were no statistically significant differences of infracted mass between the groups at initial MRI. However, in follow up MRI, the reduction of infarcted mass was significantly higher in groupA (GroupA: 36.5±8.7%, GroupB: 30.2±11.0%, GroupC: 21.2±11.0%, p=0.016), and extent of reduction in infarcted mass percent (infarcted mass/LV mass) was also significantly larger in group A (group A: 8.2±4.3%, group B: 4.7±3.5%, group C: 2.9±3.5%, p=0.018) Conclusion:Early coronary reperfusion combined with the use of distal protection device during primary PCI resulted in more reduction of delayed hyperenhancement infarct size in MRI follow-up. Our data suggests that the using protection device during primary PCI is useful in delayed infarct resorption, however the clinical importance of infart reduction in delayed hyperenhancement of follow-up MRI need to be explored.
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