Reperfusion syndrome: relationship of coronary blood flow reserve to left ventricular function and infarct size

Feldman, Laurent J.; Himbert, Dominique; Juliard, Jean‐Michel; Karrillon, G.; Benamer, Hakim; Aubry, P; Boudvillain, Olivier; Seknadji, Patrick; Faraggi, Marc; Steg, Philippe Gabriel

doi:10.1016/s0735-1097(00)00523-4

Cited by 55 publications

(45 citation statements)

References 35 publications

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“…Our electrocardiographic findings indicated that patients with a higher WBC count on admission who underwent early recanalization had less myocardial damage before recanalization than those who underwent late recanalization, but had severe myocardial damage after recanalization. This assumption is supported by a lower QRS score, more frequent ST-segment re-elevation with a greater increase in ST-segment elevation, a marker of microcirculatory reperfusion injury, 19 and severer chest pain in the patients with early recanalization. Consequently, there were no differences between the 2 groups in myocardial damage after recanalization.…”

Section: Discussionmentioning

confidence: 89%

“…Additional ST-segment elevation of at least 5 mm in leads V1-6 immediately after recanalization was defined as ST-segment reelevation. 10,11 In addition, the ECGs were scored according to the 32-point QRS score before and 1 h after recanalization (QRSpre, QRSpost). 12 The QRS score was additionally determined a mean of 14 days after AMI (QRSD14).…”

Section: Electrocardiographic Analysismentioning

confidence: 99%

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Relation Between White Blood Cell Counts and Myocardial Reperfusion in Patients With Recanalized Anterior Acute Myocardial Infarction

Kosuge

Kimura

Ishikawa

et al. 2004

Circ J

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he white blood cell (WBC) count on admission is a strong and independent predictor of increased morbidity and mortality in patients with acute myocardial infarction (AMI), 1-3 although the mechanism underlying these observations is unclear. Recent studies have reported that an elevated WBC count on admission is associated with a larger infarct size, 2,4 but whether it is the cause or the result of the large infarct remains to be determined. The development of ischemic myocardial damage may time-dependently elevate the WBC count in patients with AMI, 4 suggesting that the WBC count during the acute phase of AMI may be affected by the duration of the ischemia. Previous studies have assessed the relation between the WBC count and infarct size, without examining ischemic time, so the present study sought to clarify the relation of the WBC count on admission to infarct size and myocardial reperfusion according to ischemic time in patients with a recanalized anterior AMI. Methods Study GroupThe study group comprised 135 consecutive patients (mean age 59±11 years; 111 men, 24 women) with an AMI who fulfilled the following criteria: (1) no history of myocardial infarction; (2) complete occlusion (TIMI grade 0 flow) 5 of the left anterior descending (LAD) coronary artery on admission with achievement of TIMI grade 3 flow as confirmed by coronary angiography within 6 h of symptom onset; (3) electrocardiograms (ECGs) obtained before and after recanalization; (4) adequate assessment of myocardial blush grade after recanalization; (5) a patent LAD coronary artery as confirmed by predischarge coronary angiography, performed a mean of 14 days after AMI; and (6) no concomitant noncardiac diseases, such as inflammatory disorders, malignancy, or infection. The diagnosis of anterior AMI was based on typical chest pain lasting more than 30 min, ST-segment elevation of at least 2 mm in at least 2 contiguous precordial leads, and a subsequent increase in the serum creatine kinase (CK) concentration to more than twice the upper limit of normal. Coronary AngiographyCoronary angiography was performed immediately after admission. The grade of collateral filling in the LAD coronary artery was evaluated as described by Rentrop et al. 6 A good collateral channel was defined as grade 2 or 3, and a poor collateral channel as grade 0 or 1. The allocation of recanalization therapy was left to the attending doctor's discretion. 7,8 Recanalization was defined as the establishment of TIMI grade 3 flow. In the right coronary artery and the left circumflex coronary artery, stenosis was considered clinically significant if the lumen diameter was narrowed by 75% or more in any projection. Myocardial blush was Background The clinical significance of the white blood cell (WBC) count on admission in relation to the duration of ischemia in acute myocardial infarction (AMI) remains unclear. Methods and ResultsThe relationship of the WBC count on admission to myocardial reperfusion was examined in 135 patients with recanalization of an anterior AMI within 6...

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Section: Discussionmentioning

confidence: 89%

Section: Electrocardiographic Analysismentioning

confidence: 99%

Relation Between White Blood Cell Counts and Myocardial Reperfusion in Patients With Recanalized Anterior Acute Myocardial Infarction

Kosuge

Kimura

Ishikawa

et al. 2004

Circ J

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“…2,[5][6][7] The occurrence of the noreflow phenomenon during an acute phase of MI has a negative prognostic value. Incomplete coronary reperfusion is associated with a larger infarct size, 8,9 lower left ventricular (LV) ejection fraction, 10 increased mortality, 5,11 and more frequent congestive heart failure attributable to LV remodeling. 6,9 Main causes of this phenomenon are not fully understood and involve: microvascular embolization by the aggregates composed of platelets, erythrocytes, neutrofiles, and fragments of thrombus and ruptured plaque; endothelial dysfunction; vascular smooth muscle cell (VSMC) contraction, and surrounding tissue edema.…”

mentioning

confidence: 99%

No-Reflow Phenomenon After Acute Myocardial Infarction Is Associated With Reduced Clot Permeability and Susceptibility to Lysis

Zalewski

Undas

Godlewski

et al. 2007

ATVB

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Objective-We assessed the relationship between fibrin clot properties and the no-reflow phenomenon after primary coronary intervention (PCI). Methods and Results-Epicardial blood flow was assessed by TIMI scale and corrected TIMI frame count (cTFC), and perfusion by TIMI Myocardial Perfusion Grade (TMPG) after PCI during ST-segment elevation myocardial infarction (STEMI). Fibrin clot permeability (K s ) and susceptibility to lysis in assays using exogenous thrombin (t 50% ) and without thrombin (t TF ) were determined in 30 no-reflow patients (TIMI Յ2) and in 31 controls (TIMI-3) after uneventful 6 to 14 months from PCI. Key Words: myocardial infarction Ⅲ primary coronary angioplasty Ⅲ no-reflow phenomenon Ⅲ fibrin clot Ⅲ fibrinolysis T he efficiency of reperfusion therapy in acute myocardial infarction (MI) is limited by impaired microvascular reperfusion occurring after opening an infarct related artery (IRA). 1-3 The absence of a complete myocardial perfusion despite successful opening of the IRA is known as the no-reflow phenomenon, 4 which affects up to 30% of the primary angioplasty patients. 2,[5][6][7] The occurrence of the noreflow phenomenon during an acute phase of MI has a negative prognostic value. Incomplete coronary reperfusion is associated with a larger infarct size, 8,9 lower left ventricular (LV) ejection fraction, 10 increased mortality, 5,11 and more frequent congestive heart failure attributable to LV remodeling. 6,9 Main causes of this phenomenon are not fully understood and involve: microvascular embolization by the aggregates composed of platelets, erythrocytes, neutrofiles, and fragments of thrombus and ruptured plaque; endothelial dysfunction; vascular smooth muscle cell (VSMC) contraction, and surrounding tissue edema. 12 Complex pathways of blood coagulation lead ultimately to the formation of a fibrin clot that is preceded by thrombin-mediated fibrinogen conversion to fibrin and fibrin cross-linking by activated factor XIII. 13 The structure and function of the fibrin clot is affected by genetic and environmental factors, especially fibrinogen levels. 14 Despite the data showing that fibrin thrombi may participate in microvascular obstruction 4,12 and an early intervention in a closed artery with a large thrombus leads to distal embolization and tissue perfusion deterioration in some patients, 7,15 an association between fibrin clot properties and the no-reflow phenomenon has not yet been studied. Therefore, we sought to evaluate the fibrin clot properties in patients with impaired epicardial and tissue reperfusion after primary coronary intervention (PCI) in myocardial infarction with persistent ST-segment elevation (STEMI) in ECG. Methods PatientsSixty-one patients, 43 men, aged 62.7Ϯ10.2 years, who underwent PCI for STEMI were enrolled in this case-control study. We studied 30 consecutive patients with a final TIMI Յ2 coronary blood flow after PCI (the no-reflow group) performed 6 to 14 (average 10.2Ϯ2.5) months before the enrolment. Thirty-one Original

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“…Additional elevation of ∑ST after reperfusion is known to be associated with reperfusion injury, which causes large infarct size and poor left ventricular function. 24 Even if the initial ∑ST is less than 10 mm, adjunctive therapy might be required in patients with a high elevation of ∑ST after reperfusion.…”

Section: Present Studymentioning

confidence: 99%

Impact of the Magnitude of the Initial ST-Segment Elevation on Left Ventricular Function in Patients With Anterior Acute Myocardial Infarction

Kurisu

Inoue

Kawagoe

et al. 2004

Circ J

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Reperfusion syndrome: relationship of coronary blood flow reserve to left ventricular function and infarct size

Abstract: Patients with RS during primary PTCA for an anterior AMI have a transiently lower CVR than patients without RS, but sustained LV dysfunction and larger infarct size, suggesting that RS is a marker of microcirculatory reperfusion injury.

Cited by 55 publications

References 35 publications

Relation Between White Blood Cell Counts and Myocardial Reperfusion in Patients With Recanalized Anterior Acute Myocardial Infarction

Relation Between White Blood Cell Counts and Myocardial Reperfusion in Patients With Recanalized Anterior Acute Myocardial Infarction

No-Reflow Phenomenon After Acute Myocardial Infarction Is Associated With Reduced Clot Permeability and Susceptibility to Lysis

Impact of the Magnitude of the Initial ST-Segment Elevation on Left Ventricular Function in Patients With Anterior Acute Myocardial Infarction

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