Quality of myocardial reperfusion according to ischemic time and infarcted territory.

BACKGROUND

The relationship of the ischemic time to primary angioplasty and the quality of myocardial reperfusion according to infarcted territory among patients with ST-segment elevation myocardial infarction (STEMI) is unclear.

METHODS

This study consisted of 140 patients with STEMI within 12 h from the symptom onset and undergoing a primary angioplasty from the Protection of Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation Myocardial Infarction Trial. ST-segment resolution (STR) at 60 min was analyzed by an independent corelab using continuous ST monitoring. Patients were divided according to anterior (n=74) and nonanterior (n=64) locations and according to ischemic time in quartiles (<90, 90-148, 148-241, and 241-635 min).

RESULTS

Although there was no significant decrement in the extent of STR with the ischemic time in the entire population (74, 51, 72, and 51%, respectively, P=not significant), patients with anterior location have a significant reduction in the extent of STR after 90 min compared with those coming after 90 min (70.6 vs. 29.2% of complete STR, P=0.003, respectively).

CONCLUSION

Patients with anterior STEMI seem to have a stronger impact of ischemic time on the quality of myocardial reperfusion compared with patients with nonanterior location.