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Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct Size

Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct Size. p=0.004. p<0.001. Median = 13. Median = 14. Patients with a closed myocardium (TMPG 0/1) and patients without complete ST resolution (<70%) had larger infarcts.

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Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct Size

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  1. Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct Size p=0.004 p<0.001 Median = 13 Median = 14 Patients with a closed myocardium (TMPG 0/1) and patients without complete ST resolution (<70%) had larger infarcts. In a multivariate model, both impaired TMPG and incomplete ST resolution were independently associated with larger infarct size Median = 7 % SPECT Infarct Size Median = 6 n=108 n=113 n=209 n=111 TMPG 0/1 TMPG 2/3 Res <70% Res >70% TMPG ST Resolution Circulation 2002

  2. Early Impaired Myocardial Perfusion is Associated with Larger SPECT Infarct Size & Poorer Salvage p=0.004 Median = 13 Median = 7 % SPECT Infarct Size In a multivariate model, TMPG 2/3 remained independently associated with a higher salvage index (p=0.001) n=113 n=108 TMPG 0/1 TMPG 2/3 Angeja et al; Circulation 2002 Dibra et al, JACC 2003:41: 925-929

  3. Association of Killip Class and Impaired Myocardial Perfusion “ Patients with heart failure complicating STEMI have impaired myocardial perfusion, which accounts for the poor outcome observed in these patients”. De Luca et al, Circulation 2004;109:958-961.

  4. Associaiton of Myocardial Blush with LV Function at 4 Weeks Lepper et al AJC 2001; 88:1358-1363.

  5. Evolution of Myocardial Blush after MI 2.8% Mean of 7.5 months Hoffman et al, AJC 2003; 92: 1015-19

  6. Evolution of Myocardial Blush after MI 2.8% Mean follow-up 7.5 months Hoffman et al, AJC 2003; 92: 1015-19

  7. Left Ventricular Function in Relation to Evolution of Myocardial Blush 2.8% LVEF at mean 7.5 months Mean follow-up 7.5 months Hoffman et al, AJC 2003; 92: 1015-19

  8. Evolution of Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade During Primary Coronary Angioplasty in Acute Myocardial Infarction Predicts Long-Term Recovery of Left Ventricular Function Conclusion: Maintaining a high MPG throughout PCI in AMI or achieving a marked MPG improvement are both related to improved ST resolution, smaller areas under the curve for myonecrosis, and better ejection fractions acutely and at 6 month follow-up. *p<0.01 vs. I, **p<0.01 vs. II, †p<0.001 among I-VI, ††p<0.001 vs. I-IV, ***p<0.01 vs. EF-24h AUC: Area under curve of CK-MB release in the first 48 hours V – MPG improvement from 0/1 to 3, VI – High MPG maintained (2/3 before and 3 after PCI) Jaroslaw Zalewski et al, ACC 2004

  9. Poorer TMPG is Associated with Higher Coronary Wedge Pressure (Pressure Distal to Stenosis) 28 mm Hg Coronary Wedge Pressure 9 mm Hg Closed TMPG 0 Open TMPG > 0

  10. P=0.03 P=0.02 LVEDP >18 LVEDP 18 LVEDP >18 LVEDP 18 LVEDP >18 LVEDP >18 LVEDP 18 LVEDP 18 n=174 n=217 TMPG 0/1 TMPG 2/3 n=97 n=427 TFG 0/1 TFG 2/3 An Elevated LVEDP is Associated with an Occluded Epicardial Artery as well as Impaired TMPG Kirtane et al, J Thromb Thrombolysis 2004

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