Abstract 3006: The Association of Culprit and Non-Culprit Myocardial Perfusion with Clinical Events Following an ST-Elevation MI (STEMI): An Analysis from the CLARITY-TIMI 28 Study
Background: While impaired myocardial perfusion (TIMI Myocardial Perfusion Grade (TMPG)) has been described in non-culprit (NC) epicardial arteries in the presence of ST elevation MI (STEMI), the relationship of impaired TMPG in the NC territory to clinical outcomes has not been described. We hypothesized that impaired NC TMPG would be correlated with poorer clinical outcomes.
Methods: The association of culprit & NC TMPG with clinical events among 664 patients scheduled for diagnostic angiography 3– 8 days following fibrinolytic therapy for an acute MI was assessed in the CLARITY-TIMI 28 study. The study was a case-control design; the data were analyzed using a generalized linear mixed model that adjusted for repeated measures within a patient.
Results: Impaired TMPG (0/1) in the NC territory was correlated with impaired perfusion in the culprit territory (p = 0.007). However, independent of perfusion in the culprit territory, as the number of NC territories with impaired perfusion increased, the risk of adverse outcomes increased (see figure⇓).
Conclusions: Independent of myocardial perfusion in the culprit artery, there is an incremental rise in the risk of adverse events as the number of non-culprit artery segments with impaired perfusion increases. The mechanism(s) underlying the interaction between infarcted and non-infarcted myocardial territories is unknown, but may involve shared disorders of microvascular function, peri-infarct effects such as inflammation and edema, diffuse atherosclerosis, and the impact of wall motion abnormalities.