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How does coronary stent implantation impact on the status of the microcirculation during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction?

De Maria GL, Cuculi F, Patel N, Dawkins S, Fahrni G, Kassimis G, Choudhury RP, Forfar JC, Prendergast BD, Channon KM, Kharbanda RK, Banning AP - Eur. Heart J. (2015)

Bottom Line: In 15 of these patients (17.6% of the cohort), only a partial reduction in IMR occurred and these patients were more likely to be late presenters (pain to wire time >6 h).The extent of jeopardized myocardium [standardized beta: -0.26 (IMR unit/Bypass Angioplasty Revascularization Investigation score unit), P: 0.009] and pre-stenting IMR [standardized beta: -0.34 (IMR unit), P: 0.001] predicted a reduction in IMR after stenting (ΔIMR = post-stenting IMR - pre-stenting IMR), whereas thrombotic burden [standardized beta: 0.24 (IMR unit/thrombus score unit), P: 0.01] and deployed stent volume [standardized beta: 0.26 (IMR unit/mm(3) of stent), P: 0.01] were associated with a potentially deleterious increase in IMR.The causes of impaired microvascular function at the completion of PPCI treatment are heterogeneous, but can reflect a later clinical presentation and/or the location and extent of the thrombotic burden.

View Article: PubMed Central - PubMed

Affiliation: Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford OX39DU, UK.

No MeSH data available.


Related in: MedlinePlus

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EHV353F1: Study flow chart.

Mentions: Patients with STEMI admitted to the Oxford Heart Centre for PPCI were prospectively considered for enrolment (Figure 1). ST elevation myocardial infarction was defined as the occurrence of ongoing chest pain for at least 30 min associated with ST-segment elevation >2 mm in at least two contiguous leads. Exclusion criteria were symptom duration >12 h, the presence of severe haemodynamic instability, severe left main disease, contraindications to adenosine infusion, plain old balloon angioplasty (POBA) performance without stent implantation, and inability to restore thrombolysis in myocardial infarction (TIMI) flow >2 before stenting. The local ethics committee approved the protocol and the study was conducted in accordance with the Declaration of Helsinki.Figure 1


How does coronary stent implantation impact on the status of the microcirculation during primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction?

De Maria GL, Cuculi F, Patel N, Dawkins S, Fahrni G, Kassimis G, Choudhury RP, Forfar JC, Prendergast BD, Channon KM, Kharbanda RK, Banning AP - Eur. Heart J. (2015)

Study flow chart.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664836&req=5

EHV353F1: Study flow chart.
Mentions: Patients with STEMI admitted to the Oxford Heart Centre for PPCI were prospectively considered for enrolment (Figure 1). ST elevation myocardial infarction was defined as the occurrence of ongoing chest pain for at least 30 min associated with ST-segment elevation >2 mm in at least two contiguous leads. Exclusion criteria were symptom duration >12 h, the presence of severe haemodynamic instability, severe left main disease, contraindications to adenosine infusion, plain old balloon angioplasty (POBA) performance without stent implantation, and inability to restore thrombolysis in myocardial infarction (TIMI) flow >2 before stenting. The local ethics committee approved the protocol and the study was conducted in accordance with the Declaration of Helsinki.Figure 1

Bottom Line: In 15 of these patients (17.6% of the cohort), only a partial reduction in IMR occurred and these patients were more likely to be late presenters (pain to wire time >6 h).The extent of jeopardized myocardium [standardized beta: -0.26 (IMR unit/Bypass Angioplasty Revascularization Investigation score unit), P: 0.009] and pre-stenting IMR [standardized beta: -0.34 (IMR unit), P: 0.001] predicted a reduction in IMR after stenting (ΔIMR = post-stenting IMR - pre-stenting IMR), whereas thrombotic burden [standardized beta: 0.24 (IMR unit/thrombus score unit), P: 0.01] and deployed stent volume [standardized beta: 0.26 (IMR unit/mm(3) of stent), P: 0.01] were associated with a potentially deleterious increase in IMR.The causes of impaired microvascular function at the completion of PPCI treatment are heterogeneous, but can reflect a later clinical presentation and/or the location and extent of the thrombotic burden.

View Article: PubMed Central - PubMed

Affiliation: Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Headley Way, Oxford OX39DU, UK.

No MeSH data available.


Related in: MedlinePlus