capillary lumen
DESCRIPTION
Capillary Lumen. Time is Muscle: Delays in Symptom to Door Time are Associated with Poorer Flow in the Muscle Independent of Flow in Artery. 16% rise in risk of a closed muscle for every hour of delay in STEMI (p=0.0005) CM Gibson, JACC 2004. Swollen / Closed Anterior Myocardium. - PowerPoint PPT PresentationTRANSCRIPT
Time is Muscle: Delays in Symptom to Door Time are Associated Time is Muscle: Delays in Symptom to Door Time are Associated with Poorer Flow in the Muscle Independent of Flow in Arterywith Poorer Flow in the Muscle Independent of Flow in Artery
Time is Muscle: Delays in Symptom to Door Time are Associated Time is Muscle: Delays in Symptom to Door Time are Associated with Poorer Flow in the Muscle Independent of Flow in Arterywith Poorer Flow in the Muscle Independent of Flow in Artery
16% rise in risk of a closed muscle for every hour of delay in STEMI (p=0.0005) CM Gibson, JACC 200416% rise in risk of a closed muscle for every hour of delay in STEMI (p=0.0005) CM Gibson, JACC 2004
Capillary Lumen
Time DependentTime Dependent
Wavefront of NecrosisWavefront of Necrosis
Swollen / Closed Anterior Swollen / Closed Anterior
MyocardiumMyocardiumBlistering of CapillariesBlistering of Capillaries
& Endothelium& Endothelium
55.1
46.5
0
20
40
60
Delay in Delay in Time from Symptom Onset to Treatment and TIMI Time from Symptom Onset to Treatment and TIMI Myocardial Perfusion Grade at 60 minutesMyocardial Perfusion Grade at 60 minutes
3.02
2.72
0
1
2
3
4
n=625n=625 Tim
e fr
om
sx
on
set
to t
reat
men
t (h
rs)
Tim
e fr
om
sx
on
set
to t
reat
men
t (h
rs)
TMPG 2/3TMPG 2/3 TMPG 0/1TMPG 0/1
% T
MP
G 2
/3%
TM
PG
2/3
n=549n=549
25th/75th25th/75th
PercentilePercentile
2 / 3.752 / 3.75
25th/75th25th/75th
PercentilePercentile
2.2 / 4.052.2 / 4.05
n=258n=258
p = 0.014p = 0.014
Time to Time to treatment treatment >4 hours>4 hours
Time to Time to treatment treatment 4 hours4 hours
n=916n=916
For impaired tissue perfusion,For impaired tissue perfusion,MV OR 1.16 per hour of delayMV OR 1.16 per hour of delay
p = 0.003p = 0.003
Gibson CM, J Am Coll Cardiol 2004Gibson CM, J Am Coll Cardiol 2004
79.5
71.3
0
20
40
60
80
100
Delay in Time from Symptom Onset to Treatment and TIMI Flow Grade at 60 minutes
3.25
2.75
0
1
2
3
4
n=1,870
p < 0.001
Tim
e fr
om
sx
on
set
to t
reat
men
t (h
rs)
TFG 2/3 TFG 0/1
% T
FG
2/3
n=545
25th/75th
Percentile
2 / 3.9
25th/75th
Percentile
2.3 / 4.6
n=614
p < 0.001
Time to treatment >4 hours
Time to treatment 4 hours
n=1,801
Gibson CM, J Am Coll Cardiol 2004Gibson CM, J Am Coll Cardiol 2004
Delay in Time from Symptom Onset to Treatment and Corrected TIMI Frame Count at 60 minutes
42.9
38.2
0
10
20
30
40
50
n=583 Co
rrec
ted
TIM
I F
ram
e C
ou
nt
(fra
mes
)
n=1,679
p = 0.001
Time to treatment >4 hours
Time to treatment 4 hours
25th/75th
Percentile
27.6 / 100
25th/75th
Percentile
25 / 100
Gibson CM, J Am Coll Cardiol 2004Gibson CM, J Am Coll Cardiol 2004
Delay in Time from Symptom Onset to Treatment and Myocardial Blush on Digital Subtraction Angiography
6.6
8.0
0
2
4
6
8
10
n=213 Blu
sh B
rig
htn
ess
on
DS
A (
gra
y sc
ale)
n=745
p = 0.02
Time to treatment >4 hours
Time to treatment 4 hours
25th/75th
Percentile
2.9 / 11
25th/75th
Percentile
3.5 / 12.6
Gibson CM, J Am Coll Cardiol 2004Gibson CM, J Am Coll Cardiol 2004
12.4
16.1
0
5
10
15
20
Delay in Delay in Time from Symptom Onset to Treatment and Time from Symptom Onset to Treatment and Ejection Fraction and CollateralsEjection Fraction and Collaterals
58.855.3
0
20
40
60
n=495n=495
p < 0.0001p < 0.0001
Eje
ctio
n f
ract
ion
(%
)E
ject
ion
fra
ctio
n (
%)
Co
llat
eral
s (%
)C
oll
ater
als
(%)
n=1,360n=1,360 n=930n=930
p = 0.004p = 0.004
Time to Time to treatment treatment >4 hours>4 hours
Time to Time to treatment treatment 4 hours4 hours
n=2,546n=2,546
Time to Time to treatment treatment >4 hours>4 hours
Time to Time to treatment treatment 4 hours4 hours
Gibson CM, J Am Gibson CM, J Am Coll Cardiol 2004Coll Cardiol 2004
87.081.3
0
20
40
60
80
100
Delay in Time from Symptom Onset to Treatment and TIMI Flow Grade post-PCI
3.25
2.75
0
1
2
3
4
n=1,187
p = 0.005
Tim
e fr
om
sx
on
set
to t
reat
men
t (h
rs)
Post-PCI TFG 3
Post-PCI TFG 0/1/2
% P
ost
-PC
I T
FG
3
n=202
25th/75th
Percentile
2 / 4.1
25th/75th
Percentile
2.1 / 5
n=379
p = 0.007
Time to treatment >4 hours
Time to treatment 4 hours
n=1,010
Gibson CM, J Am Coll Cardiol 2004Gibson CM, J Am Coll Cardiol 2004
Delay in Time from Symptom Onset to Treatment and Corrected TIMI Frame Count post-PCI
24.4
22.0
0
5
10
15
20
25
n=290
Po
st-P
CI
Co
rrec
ted
TIM
I F
ram
e C
ou
nt
(fra
mes
)
n=796
p = 0.008
Time to treatment >4 hours
Time to treatment 4 hours
25th/75th
Percentile
17 / 37
25th/75th
Percentile
16 / 32
Gibson CM, J Am Coll Cardiol 2004Gibson CM, J Am Coll Cardiol 2004
49.9
45.3
0
20
40
60
Delay in Delay in Time from Symptom Onset to Treatment and TIMI Time from Symptom Onset to Treatment and TIMI Myocardial Perfusion Grade post-PCIMyocardial Perfusion Grade post-PCI
3.00
2.67
0
1
2
3
4
n=315n=315
p = 0.017p = 0.017
Tim
e fr
om
sx
on
set
to t
reat
men
t (h
rs)
Tim
e fr
om
sx
on
set
to t
reat
men
t (h
rs)
Post-PCI Post-PCI TMPG 2/3TMPG 2/3
Post-PCI Post-PCI TMPG 0/1TMPG 0/1
% P
ost
-PC
I T
MP
G 2
/3%
Po
st-P
CI
TM
PG
2/3
n=330n=330
25th/75th25th/75th
PercentilePercentile
1.9 / 3.751.9 / 3.75
25th/75th25th/75th
PercentilePercentile
2.1 / 42.1 / 4
n=150n=150
p = 0.33p = 0.33
Time to Time to treatment treatment >4 hours>4 hours
Time to Time to treatment treatment 4 hours4 hours
n=495n=495
Gibson CM, J Am Coll Cardiol 2004Gibson CM, J Am Coll Cardiol 2004
Relationship Between Time to Reperfusion, ST-Segment Resolution, Myocardial Blush Scores and Mortality With Primary Percutaneous Coronary Intervention for Acute
Myocardial Infarction: Results from the CADILLAC Trial
Relationship Between Time to Reperfusion, ST-Segment Resolution, Myocardial Blush Scores and Mortality With Primary Percutaneous Coronary Intervention for Acute
Myocardial Infarction: Results from the CADILLAC Trial
Conclusion: Early time to reperfusion is associated with a greater likelihood of successful microvascular reperfusion after primary PCI.
Brodie et al, ACC 2004
30%
35%
40%
45%
50%
55%
60%
65%
70%
<3 hrs 3-6 hrs >6 hrs
Grade 2/3 MB(p=0.007)
Complete STR*(p=0.0002)
*Defined as >70%
•The CADILLAC Trial randomized 2,082 pts with AMI to PTCA vs. stenting +/- abciximab
•Complete STR was associated with a higher frequency of MB (56% vs. 40%, p=0.0007)
•40% of pts with poor STR had good blush scores
•44% of pts with complete STR had poor blush scores
•One year mortality was lowest with optimum microvascular reperfusion (complete STR and Grade 2/3 MB) and highest with poor microvascular reperfusion (0.6% vs. 9.9%, p=0.006)
Time-to-treatment and myocardial blushTime-to-treatment and myocardial blushTime-to-treatment and myocardial blushTime-to-treatment and myocardial blush
Time-to-treatment was significantly associated with extent of ST-segment resolution, myocardial blush grade, enzymatic infarct size, and 1-year mortality
Time-to-treatment remained associated with impaired ST-segment resolution (adjusted OR 1.01 [1.01–1.02], p < 0.001) and myocardial blush (adjusted OR 1.01
[1.01–1.02], p < 0.0001) in a MV model
Time-to-treatment was significantly associated with extent of ST-segment resolution, myocardial blush grade, enzymatic infarct size, and 1-year mortality
Time-to-treatment remained associated with impaired ST-segment resolution (adjusted OR 1.01 [1.01–1.02], p < 0.001) and myocardial blush (adjusted OR 1.01
[1.01–1.02], p < 0.0001) in a MV model
Eur Heart J. 2004 Jun;25(12):1009-13Eur Heart J. 2004 Jun;25(12):1009-13