New Unexpected Data on Non-Culprit Vessels in MI

Patients with acute myocardial infarction presenting lesions in multiple vessels is not associated with reduced infarct size in non-culprit lesions, even when functionally significant. 

Nueva y discrepante información sobre los vasos no culpables en el infarto

Animal models suggest brief periods of ischemia in non-infarct territories (non-culprit) might protect culprit territory thanks to remote ischemic preconditioning.  This pre-conditioning, according to this perspective, would reduce reperfusion injury and translate into reduced infarct size. 

Ischemic preconditioning model may be used in patients with functionally significant lesions in other vessels presenting MI. 

The aim of this stud was to look into the link between functional multivessel disease and reduced infarct size in a large contemporary cohort of patients

A cardiac MR was done in 610 patients undergoing primary PCI on day 1 and after 3 months

Patients were stratified in 3 groups according to FFR measurements in non-culprit lesions: angiographic single vessel disease, FFR nonsignificant single vessel disease, or FFR-significant functional multivessel disease. 


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431 patients presented angiographic single vessel disease (71%), 35 had functional single vessel disease (6%) and 144 had functional multivessel disease (23%).

There were no significant differences in infarct size or myocardial salvage index between groups. Functional multivessel disease was not associated with larger myocardial salvage (p=0.56) or smaller infarct size (p=0.55).

These outcomes raise questions about remote ischemic pre-conditioning. 

Conclusion

Functional multivessel disease in patients undergoing primary PCI is not associated to reduced infarct size or improve myocardial salvage index.  This is important information for future cardioprotective treatment of MI patients. 

Título original: Ischemia From Nonculprit Stenosis Is Not Associated With Reduced Culprit Infarct Size in Patients with ST-Segment–Elevation Myocardial Infarction.

Referencia: Kathrine Ekström et al. Circ Cardiovasc Imaging. 2021 May 5. Online ahead of print. doi: 10.1161/CIRCIMAGING.120.012290. 


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