Acute Myocardial Infarction
Conditions
Brief summary
This study will assess relationship between ischemic time and the extent of myocardial infarction with cardiac magnetic resonance image in patients with STEMI (ST elevation myocardial infarction) and primary percutaneous coronary intervention.
Detailed description
Background: Cardiac magnetic resonance image (CMRI) is the preferred method of assessing myocardial infarct size and function. However,the relationship between CMRI changes and the ischemic time \[symptom onset to device activation time (S2D)\] in patients with primary percutaneous coronary intervention (PCI) is not well understood. Hypothesis: The investigators will test the primary hypothesis that there is strong (at least 70%) direct correlation between the S2D time and infarct size by CMRI and inverse correlation with myocardial salvage. Method: The investigators will study a prospective cohort of 80 consecutive patients with STEMI and primary PCI. The investigators will perform CMRI at day 3 to 1 post STEMI and a repeat CMRI 30 to 40 days post STEMI. Exclusion Criteria: The investigators will exclude patients with 1)-culprit lesion in the distal artery, 2)-glomerular filtration rate (GFR) \< 60 mL/min/1.73m2, 3)-pacemaker, defibrillator, aneurysm clips, 4)-body weight \> 400lb, 5)-history of allergic reactions to gadlinium based contrast agents, and 6)-those unwilling to participate in the study protocol. Outcome Measurement: The primary outcome measure is the CMRI myocardial infarct size (scar). The secondary outcomes include the CMRI transmurality of scar, area at risk, myocardial salvage index, microvascular obstruction (MVO), left ventricle (LV) thrombus, and LV ejection fraction (EF). Important covariates include symptoms and ST segment resolution before and after the PCI, peak cardiac troponin (cTn), and angiographic TIMI flow and myocardial perfusion grade. Follow-up: Patients will be followed with repeat CMRI at 30 to 40 days and with phone survey at 6 months and 12 months.
Interventions
None listed
Sponsors
Medstar Health Research Institute
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Clinical features, EKG, cTn elevation, and coronary catheterization findings consistent with an acute STEMI and having primary PCI, with age greater than 18 years, and GFR \>= 60 mL/min/1.73m2.
Exclusion criteria
1. Renal dysfunction (creatinine clearance \< 60 mL/min/1.73m2) 2. Pregnancy or breast-feeding 3. Standard contra-indications to MRI for implanted ferro-magnetic devices - i.e.: pacemakers, defibrillator (AICD), and aneurysm clips 4. Body weight \> 400lb 5. Unwilling to participate in the research protocol 6. History of allergic reactions to gadlinium based contrast agents. 7. Too critically ill to receive a MRI
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| CMRI myocardial infarct size | Patients will be followed with repeat CMRI at 30 to 40 days and with phone survey at 6 months and 12 months. | The primary outcome measure is the CMRI myocardial infarct size (scar). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CMRI area at risk | Patients will be followed with repeat CMRI at 30 to 40 days and with phone survey at 6 months and 12 months. | The secondary outcomes include the CMRI transmurality of scar, area at risk, myocardial salvage index, microvascular obstruction (MVO), left ventricle (LV) thrombus, and LV ejection fraction (EF). Important covariates include symptoms and ST segment resolution before and after the PCI, peak cardiac troponin (cTn), and angiographic TIMI flow and myocardial perfusion grade. |
| CMRI myocardial salvage index | Patients will be followed with repeat CMRI at 30 to 40 days and with phone survey at 6 months and 12 months. | The secondary outcomes include the CMRI transmurality of scar, area at risk, myocardial salvage index, microvascular obstruction (MVO), left ventricle (LV) thrombus, and LV ejection fraction (EF). Important covariates include symptoms and ST segment resolution before and after the PCI, peak cardiac troponin (cTn), and angiographic TIMI flow and myocardial perfusion grade. |
| CMRI transmurality of scar | Patients will be followed with repeat CMRI at 30 to 40 days and with phone survey at 6 months and 12 months. | The secondary outcomes include the CMRI transmurality of scar, area at risk, myocardial salvage index, microvascular obstruction (MVO), left ventricle (LV) thrombus, and LV ejection fraction (EF). Important covariates include symptoms and ST segment resolution before and after the PCI, peak cardiac troponin (cTn), and angiographic TIMI flow and myocardial perfusion grade. |
| CMRI left ventricle (LV) thrombus | Patients will be followed with repeat CMRI at 30 to 40 days and with phone survey at 6 months and 12 months. | The secondary outcomes include the CMRI transmurality of scar, area at risk, myocardial salvage index, microvascular obstruction (MVO), left ventricle (LV) thrombus, and LV ejection fraction (EF). Important covariates include symptoms and ST segment resolution before and after the PCI, peak cardiac troponin (cTn), and angiographic TIMI flow and myocardial perfusion grade. |
| CMRI LV ejection fraction (EF) | Patients will be followed with repeat CMRI at 30 to 40 days and with phone survey at 6 months and 12 months. | The secondary outcomes include the CMRI transmurality of scar, area at risk, myocardial salvage index, microvascular obstruction (MVO), left ventricle (LV) thrombus, and LV ejection fraction (EF). Important covariates include symptoms and ST segment resolution before and after the PCI, peak cardiac troponin (cTn), and angiographic TIMI flow and myocardial perfusion grade. |
| CMRI microvascular obstruction (MVO) | Patients will be followed with repeat CMRI at 30 to 40 days and with phone survey at 6 months and 12 months | The secondary outcomes include the CMRI transmurality of scar, area at risk, myocardial salvage index, microvascular obstruction (MVO), left ventricle (LV) thrombus, and LV ejection fraction (EF). Important covariates include symptoms and ST segment resolution before and after the PCI, peak cardiac troponin (cTn), and angiographic TIMI flow and myocardial perfusion grade. |
Countries
United States
Outcome results
None listed