Angiographic estimates of myocardium at risk during acute myocardial infarction: validation study using cardiac magnetic resonance imaging

Ortiz-Pérez, Josè T.; Meyers, Sheridan N.; Lee, Daniel; Kansal, Preeti; Klocke, Francis J.; Holly, Thomas A.; Davidson, Charles J.; Bonow, Robert O.; Wu, Edwin

doi:10.1093/eurheartj/ehm212

Cited by 152 publications

(111 citation statements)

References 21 publications

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“…¶ The area at risk was assessed by means of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) score. 16 The APPROACH score is a scoring system in which the left ventricle is divided into regions defined by the distribution of perfusion of each coronary artery, and the estimated amount of myocardium in each region is used to calculate the amount of jeopardized myocardium for a given site of vessel occlusion. The area at risk is expressed as the percent of the left ventricular mass.…”

Section: Discussionmentioning

confidence: 99%

Cyclosporine before PCI in Patients with Acute Myocardial Infarction

et al. 2015

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BACKGROUNDExperimental and clinical evidence suggests that cyclosporine may attenuate reperfusion injury and reduce myocardial infarct size. We aimed to test whether cyclosporine would improve clinical outcomes and prevent adverse left ventricular remodeling. METHODSIn a multicenter, double-blind, randomized trial, we assigned 970 patients with an acute anterior ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention (PCI) within 12 hours after symptom onset and who had complete occlusion of the culprit coronary artery to receive a bolus injection of cyclosporine (administered intravenously at a dose of 2.5 mg per kilogram of body weight) or matching placebo before coronary recanalization. The primary outcome was a composite of death from any cause, worsening of heart failure during the initial hospitalization, rehospitalization for heart failure, or adverse left ventricular remodeling at 1 year. Adverse left ventricular remodeling was defined as an increase of 15% or more in the left ventricular end-diastolic volume. RESULTSA total of 395 patients in the cyclosporine group and 396 in the placebo group received the assigned study drug and had data that could be evaluated for the primary outcome at 1 year. The rate of the primary outcome was 59.0% in the cyclosporine group and 58.1% in the control group (odds ratio, 1.04; 95% confidence interval, 0.78 to 1.39; P = 0.77). Cyclosporine did not reduce the incidence of the separate clinical components of the primary outcome or other events, including recurrent infarction, unstable angina, and stroke. No significant difference in the safety profile was observed between the two treatment groups. CONCLUSIONSIn patients with anterior STEMI who had been referred for primary PCI, intravenous cyclosporine did not result in better clinical outcomes than those with placebo and did not prevent adverse left ventricular remodeling at 1 year. ( n engl j med 373;11 nejm.org September 10, 2015 1022T h e ne w e ngl a nd jou r na l o f m e dicine O ver the past three decades, major progress has been made in the treatment of patients with ST-segment elevation myocardial infarction (STEMI).1 Nevertheless, the rates of death, heart failure, and recurrent ischemic events occurring in the first year after infarction remain unacceptably elevated in this highrisk population. Although many advances have been made in the development of methods to reopen the culprit coronary artery and prevent reocclusion, there is currently no specific treatment that targets myocardial reperfusion injury, which is a paradoxical form of myocardial damage that occurs as a result of the restoration of vessel patency.2 Growing evidence from experimental studies and small-size proof-of-concept clinical trials shows that reperfusion injury contributes greatly to the final infarct size.3-5 Preclinical studies indicate that the opening of the mitochondrial permeability transition pore (PTP) in the inner mitochondrial membrane plays a major role in reperfusion injury. ...

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Section: Discussionmentioning

confidence: 99%

Cyclosporine before PCI in Patients with Acute Myocardial Infarction

et al. 2015

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“…The angiograms were analyzed for collateral flow to the infarct-related artery according to the Rentrop classification grade (0-3), TIMI flow grade (0-3), and for area at risk according to the APPROACH (Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease) score (34).…”

Section: Angiographymentioning

confidence: 99%

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

et al. 2014

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Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index and infarct size adjusting for area at risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon hospital admission and infarct size in STEMI patients is a consequence of a larger myocardial area at risk but not of a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of glucose levels at hospital admission. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of risk and injury to the myocardium.

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“…84 Taking these aspects into account, Ortiz-Perez et al showed that CMR infarct endocardial surface area (ESA) measured within a week after primary PCI in STEMI patients correlated with the angiographically determined AAR. 18 The use of T 2 -weighted images in determining the AAR has its limitations. 85 In a review article, Arai et al discussed the role of T 2 -weighted MR imaging in the assessment of the AAR in patients with AMI.…”

Section: Area At Riskmentioning

confidence: 99%

“…18 In a subsequent study they reported on the correspondence between the 17-segment model and coronary artery anatomy with contrast-enhanced CMR imaging in 93 patients flowing AMI treated with primary PCI. 96 They found that four segments (2,7,8,and13) were 100% specific for LAD occlusion, while no segments were 100% specific for LCx or RCA occlusion.…”

Section: Correspondence Between Left Ventricular 17 Myocardial Segmenmentioning

confidence: 99%

Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

Rinta-Kiikka

Tuohinen

Ryymin

et al. 2014

Noninvasive Electrocardiol

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Background:Patients with acute ST-elevation myocardial infarction (STEMI) benefit substantially from emergent coronary reperfusion. The principal mechanism is to open the occluded coronary artery to minimize myocardial injury. Thus the size of the area at risk is a critical determinant of the patient outcome, although other factors, such as reperfusion injury, have major impact on the final infarct size. Acute coronary occlusion almost immediately induces metabolic changes within the myocardium, which can be assessed with both the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) imaging.Methods: The 12-lead ECG is the principal diagnostic method to detect and risk-stratify acute STEMI. However, to achieve a correct diagnosis, it is paramount to compare different ECG parameters with golden standards in imaging, such as CMR. In this review, we discuss aspects of ECG and CMR in the assessment of acute regional ischemic changes in the myocardium using the 17 segment model of the left ventricle presented by American Heart Association (AHA), and their relation to coronary artery anatomy.Results: Using the 17 segment model of AHA, the segments 12 and 16 remain controversial. There is an important overlap in myocardial blood supply at the antero-lateral region between LAD and LCx territories concerning these two segments.Conclusion: No all-encompassing correlation can be found between ECG and CMR findings in acute ischemia with respect to coronary anatomy.

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Angiographic estimates of myocardium at risk during acute myocardial infarction: validation study using cardiac magnetic resonance imaging

Cited by 152 publications

References 21 publications

Cyclosporine before PCI in Patients with Acute Myocardial Infarction

Cyclosporine before PCI in Patients with Acute Myocardial Infarction

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

Correlation of Electrocardiogram and Regional Cardiac Magnetic Resonance Imaging Findings in ST‐Elevation Myocardial Infarction: A Literature Review

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