This study was performed to evaluate the impact of time to reperfusion on infarct
size and transmurality after primary percutaneous coronary intervention (PCI) for
ST-segment elevation myocardial infarction (STEMI). In 73 patients undergoing primary
PCI for STEMI, contrast-enhanced magnetic resonance imaging was performed. Infarct
size and transmurality on delayed-enhancement imaging were measured. Infarct size
was not associated with symptom onset-to-balloon time (23 ± 9% for <180 minutes, 22
± 9% for 180 to 360 minutes, and 24 ± 11% for >360 minutes, p = 0.62) or door-to-balloon
time (23 ± 8% for <90 minutes, 23 ± 10% for 90 to 120 minutes, and 22 ± 11% for >120
minutes, p = 0.88). Infarct transmurality increased significantly with a delay of
symptom onset-to-balloon time (73 ± 22% for <180 minutes, 78 ± 14% for 180 to 360
minutes, and 86 ± 14% for >360 minutes, p = 0.04), but not for door-to-balloon time
(79 ± 15% for <90 minutes, 76 ± 19% for 90 to 120 minutes, and 81 ± 18% for >120 minutes,
p = 0.62). In multivariate analysis, anterior infarction (odds ratio 4.15, 95% confidence
interval 1.31 to 13.18, p = 0.02) and myocardial blush grade 0/1 (odds ratio [OR]
3.89, 95% confidence interval [CI] 1.13 to 13.51, p = 0.03) independently predicted
a large infarct (infarct size ≥25%). Symptom onset-to-balloon time (OR per 30 minutes
1.26, 95% CI 1.04 to 1.53, p = 0.02) was an independent predictor of transmural infarct
(average transmural extent ≥75%) and use of glycoprotein IIb/IIIa inhibitors showed
a protective effect (OR 0.09, 95% CI 0.02 to 0.53, p = 0.007). In conclusion, symptom
onset-to-balloon time was significantly associated with infarct transmurality but
not infarct size in patients undergoing primary PCI for STEMI.
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Article info
Publication history
Published online: August 21, 2008
Accepted:
June 30,
2008
Received in revised form:
June 30,
2008
Received:
May 7,
2008
Footnotes
This study was supported by grant from Cardiac and Vascular Center, Samsung Medical Center, Seoul, Republic of Korea.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
