title: Time-dependent detrimental effects of distal embolization on myocardium and microvasculature during primary percutaneous coronary intervention.
abstract: OBJECTIVE
  The authors sought to investigate the impact of distal embolization (DE) on myocardial damage and microvascular reperfusion, according to time-to-treatment, using contrast-enhanced cardiac magnetic resonance (CE-CMR).
  
  
  BACKGROUND
  DE, occurring during primary percutaneous coronary intervention (p-PCI), appears to increase myocardial necrosis and to worsen microvascular perfusion, as shown by surrogate markers. However, data regarding the behavior of DE on jeopardized myocardium, and in particular on necrosis extent and distribution, are still lacking.
  
  
  METHODS
  In 288 patients who underwent p-PCI within 6 h from symptom onset, the authors prospectively assessed the impact of DE on infarct size and microvascular damage, using CE-CMR. The impact of DE was assessed according to time-to-treatment: for group 1, <3 h; for group 2, ≥3 and ≤6 h.
  
  
  RESULTS
  DE occurred in 41 (14.3%) patients. Baseline clinical characteristics were not different between the 2 groups. At CE-CMR, patients with DE showed larger infarct size (p = 0.038) and more often transmural necrosis compared with patients without DE (p = 0.008) when time-to-treatment was <3 h, but no impact was proven after this time (p = NS). Patients with DE showed more often microvascular obstruction, as evaluated at first-pass enhancement, than patients without DE (100% vs. 66.5%, p = 0.001) up to 6 h from symptom onset.
  
  
  CONCLUSIONS
  These findings suggest that the detrimental impact of DE occurring during p-PCI on myocardial damage is largely influenced by ischemic time, increasing the extent of necrosis in patients presenting within the first hours after symptom onset, and having limited or no impact after this time window.
authors.affiliation: Laboratory of Epidemiological Methods and Biostatistics, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy. massimo.napodano@gmail.com
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Diletta
authors.initials: D
authors.lastname: Peluso
authors.forename: Martina Perazzolo
authors.initials: MP
authors.lastname: Marra
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Paolo
authors.initials: P
authors.lastname: Buja
authors.forename: Valeria
authors.initials: V
authors.lastname: Gasparetto
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.forename: Giambattista
authors.initials: G
authors.lastname: Isabella
authors.forename: Renato
authors.initials: R
authors.lastname: Razzolini
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000209:etiology*; D004617:Embolism / Q000150:complications*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis / Q000209:etiology; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D013997:Time Factors; D014652:Vascular Diseases / Q000209:etiology*