الفهرس 
? ST Segment Elevation Myocardial InfarctionOnly 14 pages are availabe for public view
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Abstract
Background:
Myocardial infarction (MI) is a major cause of death and disability worldwide. Accurate diagnosis is important, since it directs clinical management and affects prognosis, despite the development of cardiac specific biomarkers (i.e. troponins) that increase several hours after the onset of myocardial ischemia, early diagnosis can still be difficult and MI may remain undetected. Salvaging of threatened myocardium during acute coronary occlusion is a key therapeutic target. The extent of myocardium subject to ischemia is a determinant of infarct size and prognosis
The Objectives: our aim is to determine the prognostic value of different clinical and procedural variables in acute anterior ST elevation myocardial infarction patients treated with primary percutaneous intervention utilizing cardiac magnetic resonance imaging (CMR) derived myocardial salvage index.
Patients and Methods: Thirty Patients presented to our facility with acute anterior STEMI, reperfused by Primary PCI within 12 hours from symptoms onset, then assessment of CMR-derived MSI was performed on day 2 - 4 after primary PCI using 1.5 Tesla machine. MVO and infarction size volumes were evaluated in late gadolinium enhancement (LGE) CMR. Different demographic data and clinical risk factors of different patient groups were obtained. Peri-procedural aspects and time intervals of PPCI and following echocardiography were recorded for different patients. Patients were followed up clinically for Major Adverse Cardiac Events (MACE) during hospital stay and up to 6 months.
Results: Patients with lower MSI and patients with MVO had more incidence of major adverse cardiovascular events within the first 6 months post PPCI (p=0.003, p=0.001 respectively). Patients with lower MSI and patients with MVO had higher Killip class on presentation to ER (P=0.03, P=0.018 respectively). Shorter peri-procedural time intervals, total ischemic time, and time from onset of pain to resolution of ST segment deviation were clearly found in patients with higher MSI and also in patients with no or minimal MVO. Also those patients had lower enzymatic elevation of CK (total and MB fraction), smaller infarction size, better LV systolic function, and smaller LV end- systolic and end-diastolic dimensions.
Conclusion: parameters such as infarct size, MO, MSI add incremental prognostic value above the assessment of traditional risk markers alone. This allows improved identification of patients at high risk for adverse late outcome and could potentially help to optimize clinical management and subsequent outcome in these patients.