Assessment of Myocardial Salvage Index after Primary Percutaneous Intervention of ST Elevation Myocardial Infarction Patients Using Myocardial Magnetic Resonance Imaging Techniques

Objectives: The aim of this work was assessment of myocardial salvage using various magnetic resonance imaging techniques immediately after primary percutaneous coronary intervention of ST elevation myocardial infarction patients and at midterm follow up.

Methods: The current study was conducted on 30 patients referred to Aswan heart center or Cardiology department, Tanta University hospital with a diagnosis of ST elevation myocardial infarction during the period from august2017 to December 2017. All patients were subjected to history taking ,clinical assessment ,12 lead ECG, Laboratory biomarkers including cardiac enzyme biomarkers, complete blood count, liver function test, renal function test and lipid profile primary then primary percutaneous coronary intervention was done then cardiac magnetic resonance imaging within 3 days and after 3 months including the following sequences: Steady-state free precession, T2 weighted triple inversion recovery sequence and Early and late gadolinium enhancement to measure the area at risk and myocardial salvage index.

Results: Myocardial salvage index was found to improve with improving thrombolysis in myocardial infarction (TIMI) flow post intervention (p value=0.004), also the presence of microvascular obstruction (p value =0.034) and intramyocardial hemorrhage (p value=0.014) had a negative impact on myocardial salvage index. Peak cardiac enzyme biomarkers (troponin p value=0.001,CK p value=0.005,CKMB p value=0.002) were also associated with increased area at risk however did not affect the myocardial salvage index.

Conclusion: Proper management of the occluded coronary artery is a corner stone in improving myocardial salvage index which can be properly assessed with cardiac MRI.