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Implications of ventricular arrhythmia "bursts" with normal epicardial flow, myocardial blush, and ST-segment recovery in anterior ST-elevation myocardial infarction reperfusion: a biosignature of direct myocellular injury "downstream of downstream".

Publication ,  Journal Article
Majidi, M; Kosinski, AS; Al-Khatib, SM; Smolders, L; Cristea, E; Lansky, AJ; Stone, GW; Mehran, R; Gibbons, RJ; Crijns, HJ; Wellens, HJ ...
Published in: Eur Heart J Acute Cardiovasc Care
February 2015

AIMS: Establishing epicardial flow with percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is necessary but not sufficient to ensure nutritive myocardial reperfusion. We evaluated whether adding myocardial blush grade (MBG) and quantitative reperfusion ventricular arrhythmia "bursts" (VABs) surrogates provide a more informative biosignature of optimal reperfusion in patients with Thrombolysis in Myocardial Infarction (TIMI) 3 flow and ST-segment recovery (STR). METHODS AND RESULTS: Anterior STEMI patients with final TIMI 3 flow had protocol-blinded analyses of simultaneous MBG, continuous 12-lead electrocardiogram (ECG) STR, Holter VABs, and day 5-14 SPECT imaging infarct size (IS) assessments. Over 20 million cardiac cycles from >4500 h of continuous ECG monitoring in subjects with STR were obtained. IS and clinical outcomes were examined in patients stratified by MBG and VABs. VABs occurred in 51% (79/154) of subjects. Microcirculation (MBG 2/3) was restored in 75% (115/154) of subjects, of whom 53% (61/115) had VABs. No VABs were observed in subjects without microvascular flow (MBG of 0). Of 115 patients with TIMI 3 flow, STR, and MBG 2/3, those with VABs had significantly larger IS (median: 23.0% vs 6.0%, p=0.001). Multivariable analysis identified reperfusion VABs as a factor significantly associated with larger IS (p=0.015). CONCLUSIONS: Despite restoration of normal epicardial flow, open microcirculation, and STR, concomitant VABs are associated with larger myocardial IS, possibly reflecting myocellular injury in reperfusion settings. Combining angiographic and ECG parameters of epicardial, microvascular, and cellular response to STEMI intervention provides a more predictive "biosignature" of optimal reperfusion than do single surrogate markers.

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Published In

Eur Heart J Acute Cardiovasc Care

DOI

EISSN

2048-8734

Publication Date

February 2015

Volume

4

Issue

1

Start / End Page

51 / 59

Location

England

Related Subject Headings

  • Treatment Outcome
  • Percutaneous Coronary Intervention
  • Myocardial Reperfusion Injury
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Microcirculation
  • Male
  • Humans
  • Female
 

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Majidi, M., Kosinski, A. S., Al-Khatib, S. M., Smolders, L., Cristea, E., Lansky, A. J., … Krucoff, M. W. (2015). Implications of ventricular arrhythmia "bursts" with normal epicardial flow, myocardial blush, and ST-segment recovery in anterior ST-elevation myocardial infarction reperfusion: a biosignature of direct myocellular injury "downstream of downstream". Eur Heart J Acute Cardiovasc Care, 4(1), 51–59. https://doi.org/10.1177/2048872614532414
Majidi, Mohamed, Andrzej S. Kosinski, Sana M. Al-Khatib, Lilian Smolders, Ecaterina Cristea, Alexandra J. Lansky, Gregg W. Stone, et al. “Implications of ventricular arrhythmia "bursts" with normal epicardial flow, myocardial blush, and ST-segment recovery in anterior ST-elevation myocardial infarction reperfusion: a biosignature of direct myocellular injury "downstream of downstream".Eur Heart J Acute Cardiovasc Care 4, no. 1 (February 2015): 51–59. https://doi.org/10.1177/2048872614532414.
Majidi M, Kosinski AS, Al-Khatib SM, Smolders L, Cristea E, Lansky AJ, Stone GW, Mehran R, Gibbons RJ, Crijns HJ, Wellens HJ, Gorgels AP, Krucoff MW. Implications of ventricular arrhythmia "bursts" with normal epicardial flow, myocardial blush, and ST-segment recovery in anterior ST-elevation myocardial infarction reperfusion: a biosignature of direct myocellular injury "downstream of downstream". Eur Heart J Acute Cardiovasc Care. 2015 Feb;4(1):51–59.
Journal cover image

Published In

Eur Heart J Acute Cardiovasc Care

DOI

EISSN

2048-8734

Publication Date

February 2015

Volume

4

Issue

1

Start / End Page

51 / 59

Location

England

Related Subject Headings

  • Treatment Outcome
  • Percutaneous Coronary Intervention
  • Myocardial Reperfusion Injury
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Microcirculation
  • Male
  • Humans
  • Female