Author + information
- Received February 16, 2012
- Revision received June 14, 2012
- Accepted June 21, 2012
- Published online November 1, 2012.
- Massimo Napodano, MD⁎,⁎ (, )
- Diletta Peluso, MD⁎,
- Martina Perazzolo Marra, MD⁎,
- Anna Chiara Frigo, MSc†,
- Giuseppe Tarantini, MD, PhD⁎,
- Paolo Buja, MD, PhD⁎,
- Valeria Gasparetto, MD⁎,
- Chiara Fraccaro, MD⁎,
- Giambattista Isabella, MD⁎,
- Renato Razzolini, MD⁎ and
- Sabino Iliceto, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Massimo Napodano, Cardiac Catheterization Laboratories and Interventional Cardiology, Cardiology Clinic, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, 2 Via Giustiniani, 35100 Padua, Italy
Objectives 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.
Dr. Napodano served as consultant for Medrad Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 16, 2012.
- Revision received June 14, 2012.
- Accepted June 21, 2012.
- American College of Cardiology Foundation