title: Factors influencing myocardial salvage with primary angioplasty.
abstract: BACKGROUND
  The purpose of this study was to evaluate the factors influencing the salvage of jeopardized myocardium in patients treated with primary angioplasty for acute myocardial infarction.
  
  
  RESULTS
  This multicenter study involved 59 patients with acute myocardial infarction who underwent primary angioplasty without antecedent thrombolytic therapy and paired baseline (before angioplasty) and predischarge tomographic perfusion imaging by quantitative 99mTc-labeled sestamibi techniques for assessing the initial area at risk and eventual infarct size. Of the 59 patients who underwent primary angioplasty, Thrombolysis In Myocardial Infarction (TIMI) level 3 perfusion was restored in the infarct vessel in 54 patients (92%). On average, approximately one third of the left ventricular myocardial mass was initially jeopardized by the infarction in progress; eventual infarct size was 18% +/- 15% of the left ventricle; myocardial salvage was 16% +/- 17% of the left ventricle. Primary angioplasty salvaged 46% +/- 50% of initially jeopardized myocardium. Factors correlated with myocardial salvage included elapsed time from onset of pain to reperfusion, infarct location (anterior infarcts had more myocardial salvage than inferior infarcts), and residual flow to the infarct zone at preangioplasty baseline levels. In the five patients reperfused less than 2 hours from onset of pain, 80% of the jeopardized myocardium was salvaged. Myocardial salvage beyond 2 hours was much more variable.
  
  
  CONCLUSIONS
  Primary angioplasty was highly effective at restoring normal perfusion in the infarct vessel and salvaging jeopardized myocardium. The myocardial salvage was highly variable and correlated with elapsed time to reperfusion, baseline residual flow to the infarct zone, and infarct location.
authors.affiliation: St. Luke's Hospital, Mid America Heart Institute, Kansas City, Mo., USA.
authors.forename: J H
authors.initials: JH
authors.lastname: O'Keefe
authors.forename: C L
authors.initials: CL
authors.lastname: Grines
authors.forename: M A
authors.initials: MA
authors.lastname: DeWood
authors.forename: T M
authors.initials: TM
authors.lastname: Bateman
authors.forename: T F
authors.initials: TF
authors.lastname: Christian
authors.forename: R J
authors.initials: RJ
authors.lastname: Gibbons
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi
chemical_list: D017256:Technetium Tc 99m Sestamibi