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ȣ - 510802 49 |
| The Effects of Facilitated Percutaeous Coronary Intervention on myocardial infarc size in Patients with ST-segment Elevation Acute Myocardial Infarction: Single-Center, Randomized, Prospective Cardiac Magnetic Resonance Imaging Study |
| 성균관대학교 의과대학 삼성서울병원 심장혈관센터 순환기내과¹ , 영상의학과² |
| 송영빈¹, 한주용¹,권현철¹,김정혁¹,박용환¹,송봉근¹,이상엽¹,조수진¹,김준형¹,신대희¹,조성원¹,최진오¹,이상훈¹, 홍경표¹, 박정의¹ , 최연현² |
Background: Primary percutaneous coronary intervention (PCI) is more effective than fibrinolytic therapy for ST-segment elevation acute myocardial infarction (STEMI), but time to intervention can be considerable. Our aim was to investigate whether the administration of high-dose tirofiban before primary PCI could reduce myocardial infarct size, using analysis of contrast-enhanced magnetic resonance imaging (CE–MRI).
Methods: Patients with STEMI within 12 hours after symptom onset were randomized to facilitated PCI group (n=12) or to primary PCI group (n=9). The primary endpoint was infarct size and its transmural extent evaluated by the volume of delayed hyperenhancement on CE–MRI at 1 month after index procedure. The secondary endpoints were pre-PCI thrombolysis in myocardial infarction (TIMI) grade, post-PCI myocardial blush grade (MBG), ST-segment resolution on electrocardiography, and left ventricular ejection fraction on echocardiography at 6-month.
Results: Infarct size on CE-MRI was similar in the facilitated PCI group and the primary PCI group (26.0±12.4% vs. 22.2±10.0%; P = 0.46). There was a trend of large transmural extent of infarct in the facilitated PCI group, although it was not statistically significant (57.7±21.4% in the facilitated PCI group vs. 77.3±21.1% in the primary PCI group; P=0.051). The incidence of pre-PCI TIMI grade 2-3 was not significantly different (33% in the facilitated PCI group vs. 22% in the primary PCI group, P=0.66). The incidence of post-PCI MBG 2-3 was not significantly different (33% in the facilitated PCI group vs. 44% in the primary PCI group, P=0.67). There were no significant differences between the facilitated PCI and primary PCI group in the rates of ST-segment resolution at 30 minutes after the procedure (33% vs. 44%; P=0.67) and at 90 minutes (58% vs. 67%; P=0.70). The left ventricular ejection fraction on echocardiography at 6-month follow-up were similar in both groups (52.0±11.6% in the facilitated PCI group vs. 50.8±4.2% in the primary PCI group; P=0.84).
Conclusions: CE–MRI showed that the facilitated PCI did not reduce infarct size and its transmural extent.
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