doi: 10.1161/hc0302.103588
(Circulation. 2002;105:282.)
© 2002 American Heart Association, Inc.
Brief Rapid Communications |
TIMI Myocardial Perfusion Grade and ST Segment Resolution: Association With Infarct Size as Assessed by Single Photon Emission Computed Tomography Imaging
From the Department of Medicine, the University of California, San Francisco (B.G.A., H.V.B., S.G.G.); Department of Medicine, Henry Ford Hospital, Detroit, Mich (M.G., M.S., A.A.); Harvard Clinical Research Institute, Boston, Mass (S.A.M., C.M.G.); Department of Medicine, University of Vermont, Burlington (B.E.S.); Genentech, Inc, South San Francisco, Calif (A.C.R., S.G.G., H.V.B.); Florida Cardiology Group, Atlantis, Fla (S.B.); and the Mayo Clinic, Rochester, Minn (R.J.G.).
Correspondence to C. Michael Gibson, MS, MD, Director Core Cardiovascular Services, Harvard Clinical Research Institute, Director of the TIMI Data Coordinating Center, 900 Commonwealth Ave, 2nd Floor, Boston MA 02215. E-mail mgibson{at}perfuse.org
Background— The TIMI myocardial perfusion grade (TMPG) and ST-segment resolution both reflect perfusion and are associated with mortality after thrombolysis for acute myocardial infarction. We hypothesized that these measures would also be associated with infarct size by single photon emission computed tomography (SPECT).
Methods and Results— In the LIMIT AMI trial (Limitation of Myocardial Injury following Thrombolysis in Acute Myocardial Infarction) of lytic monotherapy versus lytic plus rhuMAb CD18, early 90-minute TMPG (n=221) and ST segment resolution (n=242) were compared with subsequent SPECT Technetium-99 m Sestamibi, measuring the percentage of the left ventricle with no Sestamibi uptake. Infarct sizes were larger with TMPG 0 or 1 (a closed or stained myocardium) than with TMPG 2 or 3 (open myocardium, median 13% versus 7%, P=0.004). Infarcts were also larger in patients with no ST segment resolution (median 15%) or incomplete resolution (11%) than in those with complete resolution (6%, overall P=0.0001). The difference in infarct size by TMPG persisted when stratified by category of ST resolution.
Conclusions— There may be a pathophysiological link between early restoration of tissue-level perfusion and reduced subsequent infarct size that may partially explain why these early angiographic and electrocardiographic measures are associated with long-term survival.
Key Words: myocardial infarction • microcirculation • electrocardiography • angiography • thrombolysis
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