Infarct size and mortality in patients with proximal versus mid left anterior descending artery occlusion

The intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction (INFUSE-AMI) trial

Sorin J. Brener, Bernhard Witzenbichler, Akiko Maehara, Joe Dizon, Martin Fahy, Magdi El-Omar, Jan Henk Dambrink, Philippe Genereux, Roxana Mehran, Keith Oldroyd, Helen Parise, C. Michael Gibson, Gregg W. Stone

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective This study aimed to compare infarct size and clinical outcomes in patients with proximal versus mid left anterior descending (mLAD) infarction. Background The extent of myocardium at risk is an important prognostic determinate in patients with ST-segment elevation myocardial infarction. Methods The INFUSE-AMI trial randomized patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation to intracoronary (IC) bolus abciximab versus no abciximab and to thrombus aspiration versus no aspiration. The primary end point was magnetic resonance imaging infarct size (% of left ventricular mass) at 30 days. Lesion location was independently assessed and was defined as proximal (pLAD) if present before or at first significant septal perforator branch, or mLAD if beyond. Results Among 452 patients, 292 (64.7%) had pLAD and 159 (35.3%) had mLAD occlusions. Patients with pLAD infarcts were significantly more likely to have Killip class >1 heart failure and ejection fraction <40% and to present earlier to the hospital. Proximal LAD infarcts had significantly lower rates of final Thrombolysis In Myocardial Infarction flow 3 and procedural success but similar rates of myocardial blush grade 2/3 and ST-segment resolution compared with mLAD infarcts. Infarct size at 30 days was significantly greater in the pLAD group (19.3% [9.2-25.9] vs 14.3% [6.2-18.9], P <.0001). Mortality at 30 days was also higher in the pLAD group (4.2% vs 0.6%, P =.04). The effect of IC abciximab on reducing infarct size was comparable in both groups. Conclusion ST-segment elevation myocardial infarction caused by pLAD compared with mLAD occlusion results in larger infarcts and greater mortality even with contemporary reperfusion therapy.

Original languageEnglish (US)
Pages (from-to)64-70
Number of pages7
JournalAmerican Heart Journal
Volume166
Issue number1
DOIs
StatePublished - Jul 1 2013

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Thrombectomy
Arteries
Myocardial Infarction
Mortality
Percutaneous Coronary Intervention
Infarction
Reperfusion
Myocardium
Thrombosis
Heart Failure
Magnetic Resonance Imaging
abciximab
ST Elevation Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Brener, Sorin J. ; Witzenbichler, Bernhard ; Maehara, Akiko ; Dizon, Joe ; Fahy, Martin ; El-Omar, Magdi ; Dambrink, Jan Henk ; Genereux, Philippe ; Mehran, Roxana ; Oldroyd, Keith ; Parise, Helen ; Gibson, C. Michael ; Stone, Gregg W. / Infarct size and mortality in patients with proximal versus mid left anterior descending artery occlusion : The intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction (INFUSE-AMI) trial. In: American Heart Journal. 2013 ; Vol. 166, No. 1. pp. 64-70.
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abstract = "Objective This study aimed to compare infarct size and clinical outcomes in patients with proximal versus mid left anterior descending (mLAD) infarction. Background The extent of myocardium at risk is an important prognostic determinate in patients with ST-segment elevation myocardial infarction. Methods The INFUSE-AMI trial randomized patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation to intracoronary (IC) bolus abciximab versus no abciximab and to thrombus aspiration versus no aspiration. The primary end point was magnetic resonance imaging infarct size ({\%} of left ventricular mass) at 30 days. Lesion location was independently assessed and was defined as proximal (pLAD) if present before or at first significant septal perforator branch, or mLAD if beyond. Results Among 452 patients, 292 (64.7{\%}) had pLAD and 159 (35.3{\%}) had mLAD occlusions. Patients with pLAD infarcts were significantly more likely to have Killip class >1 heart failure and ejection fraction <40{\%} and to present earlier to the hospital. Proximal LAD infarcts had significantly lower rates of final Thrombolysis In Myocardial Infarction flow 3 and procedural success but similar rates of myocardial blush grade 2/3 and ST-segment resolution compared with mLAD infarcts. Infarct size at 30 days was significantly greater in the pLAD group (19.3{\%} [9.2-25.9] vs 14.3{\%} [6.2-18.9], P <.0001). Mortality at 30 days was also higher in the pLAD group (4.2{\%} vs 0.6{\%}, P =.04). The effect of IC abciximab on reducing infarct size was comparable in both groups. Conclusion ST-segment elevation myocardial infarction caused by pLAD compared with mLAD occlusion results in larger infarcts and greater mortality even with contemporary reperfusion therapy.",
author = "Brener, {Sorin J.} and Bernhard Witzenbichler and Akiko Maehara and Joe Dizon and Martin Fahy and Magdi El-Omar and Dambrink, {Jan Henk} and Philippe Genereux and Roxana Mehran and Keith Oldroyd and Helen Parise and Gibson, {C. Michael} and Stone, {Gregg W.}",
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Infarct size and mortality in patients with proximal versus mid left anterior descending artery occlusion : The intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction (INFUSE-AMI) trial. / Brener, Sorin J.; Witzenbichler, Bernhard; Maehara, Akiko; Dizon, Joe; Fahy, Martin; El-Omar, Magdi; Dambrink, Jan Henk; Genereux, Philippe; Mehran, Roxana; Oldroyd, Keith; Parise, Helen; Gibson, C. Michael; Stone, Gregg W.

In: American Heart Journal, Vol. 166, No. 1, 01.07.2013, p. 64-70.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Infarct size and mortality in patients with proximal versus mid left anterior descending artery occlusion

T2 - The intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction (INFUSE-AMI) trial

AU - Brener, Sorin J.

AU - Witzenbichler, Bernhard

AU - Maehara, Akiko

AU - Dizon, Joe

AU - Fahy, Martin

AU - El-Omar, Magdi

AU - Dambrink, Jan Henk

AU - Genereux, Philippe

AU - Mehran, Roxana

AU - Oldroyd, Keith

AU - Parise, Helen

AU - Gibson, C. Michael

AU - Stone, Gregg W.

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Objective This study aimed to compare infarct size and clinical outcomes in patients with proximal versus mid left anterior descending (mLAD) infarction. Background The extent of myocardium at risk is an important prognostic determinate in patients with ST-segment elevation myocardial infarction. Methods The INFUSE-AMI trial randomized patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation to intracoronary (IC) bolus abciximab versus no abciximab and to thrombus aspiration versus no aspiration. The primary end point was magnetic resonance imaging infarct size (% of left ventricular mass) at 30 days. Lesion location was independently assessed and was defined as proximal (pLAD) if present before or at first significant septal perforator branch, or mLAD if beyond. Results Among 452 patients, 292 (64.7%) had pLAD and 159 (35.3%) had mLAD occlusions. Patients with pLAD infarcts were significantly more likely to have Killip class >1 heart failure and ejection fraction <40% and to present earlier to the hospital. Proximal LAD infarcts had significantly lower rates of final Thrombolysis In Myocardial Infarction flow 3 and procedural success but similar rates of myocardial blush grade 2/3 and ST-segment resolution compared with mLAD infarcts. Infarct size at 30 days was significantly greater in the pLAD group (19.3% [9.2-25.9] vs 14.3% [6.2-18.9], P <.0001). Mortality at 30 days was also higher in the pLAD group (4.2% vs 0.6%, P =.04). The effect of IC abciximab on reducing infarct size was comparable in both groups. Conclusion ST-segment elevation myocardial infarction caused by pLAD compared with mLAD occlusion results in larger infarcts and greater mortality even with contemporary reperfusion therapy.

AB - Objective This study aimed to compare infarct size and clinical outcomes in patients with proximal versus mid left anterior descending (mLAD) infarction. Background The extent of myocardium at risk is an important prognostic determinate in patients with ST-segment elevation myocardial infarction. Methods The INFUSE-AMI trial randomized patients with anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation to intracoronary (IC) bolus abciximab versus no abciximab and to thrombus aspiration versus no aspiration. The primary end point was magnetic resonance imaging infarct size (% of left ventricular mass) at 30 days. Lesion location was independently assessed and was defined as proximal (pLAD) if present before or at first significant septal perforator branch, or mLAD if beyond. Results Among 452 patients, 292 (64.7%) had pLAD and 159 (35.3%) had mLAD occlusions. Patients with pLAD infarcts were significantly more likely to have Killip class >1 heart failure and ejection fraction <40% and to present earlier to the hospital. Proximal LAD infarcts had significantly lower rates of final Thrombolysis In Myocardial Infarction flow 3 and procedural success but similar rates of myocardial blush grade 2/3 and ST-segment resolution compared with mLAD infarcts. Infarct size at 30 days was significantly greater in the pLAD group (19.3% [9.2-25.9] vs 14.3% [6.2-18.9], P <.0001). Mortality at 30 days was also higher in the pLAD group (4.2% vs 0.6%, P =.04). The effect of IC abciximab on reducing infarct size was comparable in both groups. Conclusion ST-segment elevation myocardial infarction caused by pLAD compared with mLAD occlusion results in larger infarcts and greater mortality even with contemporary reperfusion therapy.

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U2 - 10.1016/j.ahj.2013.03.029

DO - 10.1016/j.ahj.2013.03.029

M3 - Article

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SP - 64

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JO - American Heart Journal

JF - American Heart Journal

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