Stiermaier Thomas, Eitel Ingo, de Waha Suzanne, Pöss Janine, Fuernau Georg, Thiele Holger, Desch Steffen
University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
Int J Cardiovasc Imaging. 2017 Oct;33(10):1571-1579. doi: 10.1007/s10554-017-1143-x. Epub 2017 Apr 24.
Primary percutaneous coronary intervention (PCI) is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) presenting within 12 h of symptom onset. A benefit in the subacute stage is less clear. The aim of the present analysis was to compare myocardial salvage and infarct size between patients with early and late reperfusion after STEMI. We compared cardiac magnetic resonance (CMR) data from a randomized controlled trial (RCT) in STEMI patients presenting within 12 h (n = 695) and a RCT of subacute STEMI patients presenting between 12 and 48 h (n = 93) after symptom onset. CMR imaging was performed 3.9 ± 6.3 days after myocardial infarction. Analyses were performed for an unmatched cohort comprising all patients (n = 788) and a cohort matched for area at risk (n = 186). In the overall cohort, area at risk was similar in both groups [37.1 ± 16.1% of left ventricular mass (%LV) vs. 38.3 ± 16.2%LV; p = 0.50]. Compared to STEMI patients with early reperfusion, patients with late PCI demonstrated larger infarct size (18.0 ± 12.5%LV vs. 28.9 ± 16.9%LV; p < 0.01) and higher extent of microvascular obstruction (1.5 ± 2.9%LV vs. 2.7 ± 4.1%LV; p = 0.01). Myocardial salvage index was significantly smaller in patients with late reperfusion (52.1 ± 25.9 vs. 27.4 ± 26.0; p < 0.01). Analysis of the matched cohorts confirmed the decreased myocardial salvage (p < 0.01) and increased infarct size (p < 0.01) in case of late reperfusion. Compared to patients with timely primary PCI, late reperfusion after STEMI results in decreased myocardial salvage and increased infarct size. However, salvageable myocardium was also found in subacute stages of STEMI.
直接经皮冠状动脉介入治疗（PCI）是症状发作12小时内就诊的ST段抬高型心肌梗死（STEMI）患者的首选治疗方法。在亚急性期的获益尚不清楚。本分析的目的是比较STEMI患者早期和晚期再灌注后的心肌挽救情况和梗死面积。我们比较了一项针对症状发作12小时内就诊的STEMI患者的随机对照试验（RCT）（n = 695）和一项针对症状发作12至48小时后就诊的亚急性STEMI患者的RCT（n = 93）的心脏磁共振（CMR）数据。心肌梗死后3.9±6.3天进行CMR成像。对包括所有患者的非匹配队列（n = 788）和根据危险区域匹配的队列（n = 186）进行分析。在整个队列中，两组的危险区域相似[左心室质量的37.1±16.1%（%LV）对38.3±16.2%LV；p = 0.50]。与早期再灌注的STEMI患者相比，晚期PCI患者的梗死面积更大（18.0±12.5%LV对28.9±16.9%LV；p < 0.01），微血管阻塞程度更高（1.5±2.9%LV对2.7±4.1%LV；p = 0.01）。晚期再灌注患者的心肌挽救指数明显较小（52.1±25.9对27.4±26.0；p < 0.01）。对匹配队列的分析证实，晚期再灌注时心肌挽救减少（p < 0.01），梗死面积增加（p < 0.01）。与及时进行直接PCI的患者相比，STEMI后晚期再灌注导致心肌挽救减少和梗死面积增加。然而，在STEMI的亚急性期也发现了可挽救的心肌。
