title: Improving myocardial salvage in late presentation acute ST-elevation myocardial infarction with proximal embolic protection.
abstract: BACKGROUND
  Late-presenting ST-elevation myocardial infarction (STEMI) patients possess larger, more organized coronary thrombus leading to greater ventricular remodeling and arrhythmia despite angioplasty and pharmacological therapies. We hypothesized that myocardial injury would be reduced in late STEMI by proximal embolic protection (PEP).
  
  
  METHODS
  31 patients with first STEMI 12-24 hr after pain onset and TIMI 0-1 flow were treated with or without PEP (cohort design matched for age, gender, and infarct-related artery). Contrast-enhanced magnetic resonance determined myocardial function, area at risk, necrosis, salvaged myocardium, and arrythmogenic peri-infarct region. Clinical follow-up was performed.
  
  
  RESULTS
  Pain to balloon time was 18 hr (95% CI 15.5-21.2 h), and Q waves were present in 87%. Angioplasty was performed with PEP in 15 and without in 16. Left ventricular (LV) volumes and ejection fraction were similar (EF 46.9% vs. 49.0% without PEP, P = 0.9). Although myocardial necrosis was similar (32.5 vs. 37.3% of LV, P = 0.3), PEP improved microvascular obstruction (8.7 vs. 11.2% of LV, P = 0.02) salvaged myocardium (39.6% vs. 29.6% of area at risk, P = 0.001), and the peri-infarct region (20.9 vs. 29.6% of infarct, P < 0.0001). On multivariate analysis, the use of PEP was an independent predictor of decreased arrythmogenic peri-infarct region and greater myocardial salvage.
  
  
  CONCLUSIONS
  In this pilot study, PEP improved myocardial salvage and the arrythmogenic peri-infarct region in late-presentation STEMI. Randomized trials are required to assess the clinical impact of improving salvaged myocardium and the peri-infarct region with PEP.
authors.affiliation: Cardiac Catheterization Laboratories, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval, Québec, Canada. Eric.Larose@criucpq.ulaval.ca
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Helena
authors.initials: H
authors.lastname: Tizon-Marcos
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Can M
authors.initials: CM
authors.lastname: Nguyen
authors.forename: Onil
authors.initials: O
authors.lastname: Gleeton
authors.forename: Jean-Rock
authors.initials: JR
authors.lastname: Boudreault
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.forename: Bernard
authors.initials: B
authors.lastname: Noël
authors.forename: Guy
authors.initials: G
authors.lastname: Proulx
authors.forename: Jacques
authors.initials: J
authors.lastname: Rouleau
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D057505:Embolic Protection Devices; D004617:Embolism / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D010865:Pilot Projects; D011446:Prospective Studies; D011792:Quebec; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media