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Nuklearmedizin 2008; 47(01): 56-61
DOI: 10.3413/nukmed-0117
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Schattauer GmbH

Determinants of final infarct size and incidence of aborted infarction in patients treated with primary coronary intervention and adjunctive abciximab therapy

Determinanten der endgültigen Infarktgröße und Häufigkeit des abortiven Infarkts bei mit Primär-PCI und zusätzlicher Abciximab-Therapie behandelten Patienten
R. Sciagrà
1   Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence
,
G. Parodi
2   Division of Cardiology, Careggi Hospital, Florence, Italy
,
B. Sotgia
1   Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence
,
D. Antoniucci
2   Division of Cardiology, Careggi Hospital, Florence, Italy
,
A. Pupi
1   Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence
› Author Affiliations
Further Information

Publication History

Received: 03 May 2007

accepted in revised form: 11 July 2007

Publication Date:
02 January 2018 (online)

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Summary

Aims: Assess the determinants of final infarct size in patients successfully treated with primary percutaneous coronary intervention (PCI) and abciximab therapy and check whether infarct abortion may occur. Patients, methods: In 208 patients we examined the parameters that predict final infarct size and the incidence of aborted infarction, defined by completely normal perfusion and regional wall motion plus > 50% left ventricular ejection fraction (LVEF) in gated single-photon emission computed tomography (SPECT) acquired at one month. Results: In linear regression analysis, sex (p < 0.0001), high cholesterol (p < 0.05), Killip class (p < 0.0001), symptom-to-reperfusion time (p < 0.001), admission ST segment elevation (p < 0.0001), infarct related artery (p < 0.05), and pre-procedural TIMI flow (p < 0.002) were significant univariate predictors of final infarct size. In multiple linear regression analysis, symptom-to-reperfusion time (p < 0.001), Killip class (p < 0.0001), ST segment elevation (p < 0.003), and sex (p < 0.03) remained significant predictors, model R2 = 0.53. Aborted infarction was registered in 32 patients, more frequently female (59% versus 21%, p < 0.00001), older (p < 0.02), with larger prevalence of TIMI grade 3 (p < 0.05) and lower ST segment elevation at admission (p < 0.05). Conclusions: Sex, reperfusion delay, and initial infarct severity as indicated by Killip class and/or ST segment elevation appear the determinants of final infarct size in patients treated with primary PCI. The presence of aborted infarction seems related to the same factors and to preserved TIMI 3 flow.

Zusammenfassung

Ziel: Bestimmung der Determinanten der endgültigen Infarktgröße in Patienten, die erfolgreich mit Primär-PCI (perkutaner Koronarintervention) und Abciximab-Therapie behandelt wurden. Patienten, Methoden: In 208 Patienten untersuchten wir die Prädiktoren der endgültigen Infarktgröße und des Vorkommens eines abortiven Infarkts, der als Befund vollkommener normaler Durchblutung und regionaler Wandbewegung zusammen mit >50% linksventrikulärer Ejektionsfraktion in nach einem Monate durchgeführter Gated Single-Photon-Emissionscomputertomographie definiert wurde. Ergebnisse: In Regressionanalyse, Geschlecht (p < 0,0001), erhöhter Cholesterinspiegel (p < 0,05), Killip Klasse (p < 0,0001), Zeit bis zur Rekanalisation (p < 0,001), ST-Strecken-Hebung bei der Aufnahme (p < 0,0001), Infarktarterie (p < 0,05) und präintervention TIMI-Fluss (p < 0,002) waren signifikante univariate Prädiktoren der endgültigen Infarktgröße. In Multivarianzanalyse, Zeit bis zur Rekanalisation (p < 0,001), Killip-Klasse (p < 0,0001), ST-Strecken-Hebung (p < 0,003) und Geschlecht (p < 0,03) blieben signifikante Prädiktoren, Modell R2 = 0,53. Abortiver Infarkt wurde in 32 Patienten nachgeprüft, öfter weiblich (59% gegen 21%, p < 0,00001) und älter (p < 0,02), mit häufiger Vorhandensein eines TIMI-3-Flusses (p < 0,05) und niedriger ST-Strecken-Hebung bei der Aufnahme (p < 0,05). Schlussfolgerung: Geschlecht, Rekanalisationsverzögerung und anfängliche Infarktschwere, wie von Killip-Klasse und/oder ST-Strecken-Hebung bestimmt, scheinen die Determinanten der endgültigen Infarktgröße in mit Primär-PCI behandelten Patienten. Das Vorhandensein des abortiven Infarkts scheint mit denselben Faktoren und mit aufbewahrtem TIMI-3-Fluss zu entsprechen.

Keywords

Acute myocardial infarction - gated single-photon emission computed tomography - myocardial perfusion scintigraphy - percutaneous coronary intervention

Schlüsselwörter

Akuter Myokardinfarkt - gated Single-Photon-Emissionscomputertomographie - Myokardszintigraphie - perkutaner Koronarintervention
 

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