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European Heart Journal Advance Access originally published online on April 8, 2009
European Heart Journal 2009 30(11):1322-1330; doi:10.1093/eurheartj/ehp113
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Infarct size and myocardial salvage after primary angioplasty in patients presenting with symptoms for <12 h vs. 12–72 h

Martin Busk1,*, Anne Kaltoft1, Søren S. Nielsen2, Morten Bøttcher1, Michael Rehling2, Leif Thuesen1, Hans E. Bøtker1, Jens F. Lassen1, Evald H. Christiansen1, Lars R. Krusell1, Henning R. Andersen1, Torsten T. Nielsen1 and Steen D. Kristensen1

1 Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus 8200, Denmark
2 Department of Nuclear Medicine, Aarhus University Hospital, Skejby, Aarhus, Denmark

Received 8 December 2008; revised 14 January 2009; accepted 4 March 2009; online publish-ahead-of-print 8 April 2009.

* Corresponding author. Tel: +45 894 962 29, Fax: +45 894 960 09, Email: martin.busk{at}ki.au.dk

Aims: Primary angioplasty for ST-segment elevation myocardial infarction (STEMI) is recommended only if symptom duration is <12 h. We evaluated final infarct size (FIS) and myocardial salvage in early presenters (<12 h) vs. late presenters (12–72 h) undergoing primary angioplasty.

Methods and results: Myocardial perfusion imaging (MPI) was performed acutely to assess area at risk (AAR) before angioplasty and repeated after 30 days to assess FIS (% of LV myocardium), salvage index (% non-infarcted AAR), and left ventricular ejection fraction (LVEF). Late presenters (n = 55) compared with early presenters (n = 341) had larger median FIS [14% (inter-quartile range 3–30) vs. 7% (2–18), P = 0.005], lower salvage index [53% (27–89) vs. 69% (45–91), P = 0.05], and lower LVEF [48% (44–58%) vs. 53% (47–59), P = 0.04]. However, FIS, salvage index, and LVEF correlated weakly with symptom duration (R2-values <0.10). In patients with TIMI-flow 0 (n = 247), late presenters had lower salvage index than early presenters [44% (23–73) vs. 57% (42–86), P = 0.03], but substantial salvage (>50% of AAR) was observed in 41% of late presenters despite total infarct-artery occlusion.

Conclusion: FIS is larger in late presenters (>12 h) than early presenters after primary angioplasty for STEMI. However, substantial myocardial salvage can be obtained beyond the 12 h limit, even when the infarct-related artery is totally occluded.

Key Words: Myocardial infarction • Angioplasty • Time factor • Radionuclide imaging


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