Abstract
BackgroundInfarct evolution rate and response to acute reperfusion therapy may differ between patients, which is important to consider for accurate management and treatment of patients with ST-elevation myocardial infarction (STEMI).The aim of this study was therefore to investigate the association of infarct size and myocardial salvage with gender, smoking status, presence of diabetes or history of hypertension in a cohort of STEMI-patients.MethodsPatients (n = 301) with first-time STEMI from the three recent multi-center trials (CHILL-MI, MITOCARE and SOCCER) underwent cardiac magnetic resonance (CMR) imaging to determine myocardium at risk (MaR) and infarct size (IS). Myocardial salvage index (MSI) was calculated as MSI = 1-IS/MaR. Pain to balloon time, culprit vessel, trial treatments, age, TIMI grade flow and collateral flow by Rentrop grading were included as explanatory variables in the statistical model.ResultsWomen (n = 66) had significantly smaller MaR (mean difference: 5.0 ± 1.5% of left ventricle (LV), p < 0.01), smaller IS (mean difference: 5.1 ± 1.4% of LV, p = 0.03), and larger MSI (mean difference: 9.6 ± 2.8% of LV, p < 0.01) compared to men (n = 238). These differences remained significant when adjusting for other explanatory variables. There were no significant effects on MaR, IS or MSI for diabetes, hypertension or smoking.ConclusionsFemale gender is associated with higher myocardial salvage and smaller infarct size suggesting a pathophysiological difference in infarct evolution between men and women.
Highlights
Ischemic heart disease (IHD) is a major cause of death worldwide
Female gender was associated with smaller myocardium at risk (MaR) while anterior injury and adjuvant hypothermia-treatment was associated with larger MaR in the multivariable analysis (Table 3)
Pre percutaneous coronary intervention (PCI) TnT < 15 ng/L = a blood sample acquired before coronary intervention showing a troponin T value < 15 ng/L, TRO40303 = the study treatment in the mitocare trial LVM left ventricular mass, BSA body surface area, MaR myocardium at risk, Myocardial salvage index (MSI) myocardial salvage index
Summary
In the acute setting of IHD, a coronary occlusion may cause ischemia which gradually develops into myocardial infarction unless the myocardium is reperfused [1,2,3]. Reperfusion therapy has revolutionized the care for these patients but the decision whether to Factors such as gender, smoking, history of hypertension and diabetes have all been implicated to affect risk after. Presence of diabetes at the time of ischemic injury is associated with higher mortality and development of heart failure [16, 17], even when adjusted for systolic function [18]. The aim of this study was to investigate the association of infarct size and myocardial salvage with gender, smoking status, presence of diabetes or history of hypertension in a cohort of STEMI-patients
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