title: [Minimum salvaged myocardium after rescue percutaneous coronary intervention: quantification by cardiac magnetic resonance].
abstract: OBJECTIVE
  When fibrinolysis fails in patients with ST elevation myocardial infarction, they are referred for a rescue percutaneous coronary intervention (PCI). However, there is still no evidence of how much myocardium potentially at risk we can actually salvage after rescue PCI.
  
  
  METHODS
  Fifty consecutive patients. Cardiac magnetic resonance was performed within 6 days. Myocardial necrosis was defined by the extent of abnormal late enhancement, myocardium at risk by extent of edema, and the amount of salvaged myocardium by the difference between myocardium at risk and myocardial necrosis. Finally, myocardial salvage index (MSI) resulted from the fraction (area-at-risk minus infarct-size)/area-at-risk.
  
  
  RESULTS
  The mean time elapsed between pain onset and fibrinolitic agent administration was 176 ± 113 min; time lysis-rescue=PCI 209 ± 122 min; time pain onset-PCI = 390 ± 152 min. The area at risk was 37% ± 13% and infarct size 34.5% ± 13%. Salvaged myocardium was 3% ± 4% and MSI 9 ± 8. Salvaged myocardium and MSI were similar between patients with the artery open on arrival at the catheterization lab (Thrombolysis in Myocardial Infarction [TIMI] 3) and those with TIMI flow ≤ 2 (3.3% ± 3.6% and 8.2 ± 6.9 in TIMI 0-2 vs 3.0% ± 3.7% and 10.8 ± 10.9 in TIMI 3; P=.80 and 0.31, respectively). No significant difference was observed between patients who went through rescue PCI within a shorter time and those with longer delay times.
  
  
  CONCLUSIONS
  The myocardial salvage after rescue PCI quantified by cardiac magnetic resonance is very small. The long delay times between pain onset and the opening of the infarct-related artery with PCI are most probably the reason for such a minimal effect of rescue PCI.
authors.affiliation: Departamento de Cardiología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Ruiz-Nodar
authors.forename: Eloísa
authors.initials: E
authors.lastname: Feliu
authors.forename: Jessica
authors.initials: J
authors.lastname: Sánchez-Quiñones
authors.forename: José
authors.initials: J
authors.lastname: Valencia-Martín
authors.forename: Milagros
authors.initials: M
authors.lastname: García
authors.forename: Javier
authors.initials: J
authors.lastname: Pineda
authors.forename: Patricia
authors.initials: P
authors.lastname: Martín
authors.forename: Vicente
authors.initials: V
authors.lastname: Mainar
authors.forename: Pascual
authors.initials: P
authors.lastname: Bordes
authors.forename: Santiago
authors.initials: S
authors.lastname: Heras
authors.forename: María A
authors.initials: MA
authors.lastname: Quintanilla
authors.forename: Francisco
authors.initials: F
authors.lastname: Sogorb
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006328:Cardiac Catheterization; D003331:Coronary Vessels / Q000473:pathology; D004487:Edema / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D012306:Risk; D015912:Thrombolytic Therapy; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents