One-Week and 6-Month Cardiovascular Magnetic Resonance Outcome of the Pharmacoinvasive Strategy and Primary Angioplasty for the Reperfusion of ST-Segment Elevation Myocardial Infarction

• Published in: Revista española de cardiologia 2011-02, Vol.64 (2), p.111-120
• Main Authors: Bodí, Vicente, Rumiz, Eva, Merlos, Pilar, Nunez, Julio, López-Lereu, Maria P., Monmeneu, José V., Chaustre, Fabián, Moratal, David, Trapero, Isabel, Blasco, Maria L., Oltra, Ricardo, Sanjuán, Rafael, Chorro, Francisco J., Llàcer, Àngel, Sanchis, Juan
• Format: Article
• Language: English
• Subjects: Aged; Angioplastia primaria; Angioplasty, Balloon, Coronary - mortality; Cardiac Catheterization; Endpoint Determination; Female; Follow-Up Studies; Humans; Infarto de miocardio con elevación del segmento ST; Magnetic Resonance Angiography - methods; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Infarction - pathology; Myocardial Infarction - therapy; Myocardial Reperfusion Injury - mortality; Myocardial Reperfusion Injury - therapy; Primary angioplasty; Prospective Studies; Reperfusion - methods; Resonancia magnética cardiaca; ST-segment elevation myocardial infarction; Thrombolysis; Thrombolytic Therapy; Treatment Outcome; Trombolisis; Ventricular Dysfunction, Left - etiology
• ISSN: 1885-5857; 1885-5857; 1579-2242
• DOI: 10.1016/j.rec.2010.10.010

Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004–2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angioplasty). During the period 2007–2008, 93 patients were treated with primary angioplasty. A propensity score matched population was also evaluated. At 1-week cardiovascular magnetic resonance, pharmacoinvasive strategy and primary angioplasty patients showed a similar extent of area at risk (29 ± 15 vs. 29 ± 17%, P = .9). Non-significant differences were detected by cardiovascular magnetic resonance at 1 week and at 6 months in infarct size, salvaged myocardium, microvascular obstruction, ejection fraction, end-diastolic volume index and end-systolic volume index ( P > .2 in all cases). The same trend was observed in 1-to-1 propensity score matched patients. The rate of major adverse cardiac events (death and/or re-infarction) at 1 year was 6% in pharmacoinvasive strategy and 7% in primary angioplasty patients ( P = .7). A pharmacoinvasive strategy including thrombolysis and routine non-immediate angioplasty represents a widely available and logistically attractive approach that yields identical short-term and long-term cardiovascular magnetic resonance-derived left ventricular outcome compared to primary angioplasty. La estrategia farmacoinvasiva es una alternativa atractiva a la angioplastia primaria. Valoramos mediante resonancia magnética cardiaca la afección del ventrículo izquierdo tras un infarto de miocardio con elevación del segmento ST tratado con estas estrategias de reperfusión. Estudiamos con resonancia magnética cardiaca, realizada 1 semana y 6 meses después de un infarto, a dos cohortes consecutivas de pacientes incluidas en un registro prospectivo de infarto de miocardio con elevación del ST en un hospital universitario. Durante el periodo 2004–2006, se trató a 151 pacientes con estrategia farmacoinvasiva (trombolisis seguida de angioplastia sistemática no inmediata). Durante el periodo 2007–