Abstract 14749: Anatomic and Physiologic Determinants of the Area-at-Risk Differentiate in Range of Infarct Size among Patients Undergoing Primary Percutaneous Coronary Intervention
Background: Quantifying salvageable area at risk (SAAR) in acute STEMI could require combining anatomic and physiologic parameters, from angiographic and ECG measures, respectively. We hypothesized that patients with combined large anatomic distribution (angiographic Duke Jeopardy score) and high ECG acuteness would have the greatest SAAR as reflected by the biggest MI size and widest distribution.
Methods: 193 pts from the PREPARE trial with complete core-laboratory angiographic, continuous ECG monitoring and imaging data were stratified by angiographic Duke jeopardy score (high (>4) vs. low (=<4) score) and peak ECG ST-deviation (high >500 uV vs. low =<500uV STD). The distribution of final MI size by MRI was then examined in 4 groups with 1) High jeopardy, high STD, 2) High jeopardy, low STD, 3) Low jeopardy, high STD, 4) Low jeopardy, low STD. Comparisons were performed using ANOVA with posthoc Tamhane testing for unequal variances.
Results: Overall, patients had a mean age of 59.4±11.3 years, 22.2% were women and the mean IS was 12.6±11.3g. The 193 pts were distributed with 38 in group 1, 32 in group 2, 57 in group 3 and 66 in group 4 (low/low). As shown in Figure 1, the widest range of MI size was in group 1, smallest in group 4 (18.4±12.6g vs 8.1±8.6 g, respectively, p<0.001).
Conclusion: Combined acute angiographic and ECG parameters identify anatomically large areas at risk that are still physiologically active, a more quantitatively precise signature of SAAR. This may be helpful for patient selection both for clinical and research applications.
- © 2012 by American Heart Association, Inc.