Microvascular damage after rescue PCI – A prognostic marker for left ventricular function?

Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients presenting with acute ST-segment elevation myocardial infarction (STEMI), if it can be performed promptly [ [1] Ibanez B. James S. Agewall S. et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2018; 39: 119-177https://doi.org/10.1093/eurheartj/ehx393 Crossref PubMed Scopus (6110) Google Scholar ]. Nevertheless, a subgroup of patients still needs to be treated via thrombolysis due to logistic difficulties in accessing a center in a timely manner [ [2] Caluza A.C. Barbosa A.H. Gonçalves I. Oliveira C.A. Matos L.N. Zeefried C. Moreno A.C. Tarkieltaub E. Alves C.M. Carvalho A.C. ST-Elevation myocardial infarction network: systematization in 205 cases reduced clinical events in the public health care system. Arq. Bras. Cardiol. 2012 Nov; 99: 1040-1048 Crossref PubMed Google Scholar ]. Thrombolysis is however limited by a high number of reperfusion failure. A study by Chesebro et al. reported that thrombolysis is unsuccessful in revascularization of the infarct related artery in 62% of patients treated with recombinant tissue plasminogen activator and 31% of patients treated with streptokinase [ [3] Chesebro J.H. Knatterud G. Roberts R. Borer J. Cohen L.S. Dalen J. Dodge H.T. Francis C.K. Hillis D. Ludbrook P. et al. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987 Jul; 76: 142-154 Crossref PubMed Scopus (2046) Google Scholar ]. In these cases of failed thrombolysis, rescue PCI is necessary to reestablish myocardial perfusion [ [4] de Souza M.T. Ybarra L.F. Oliveira T.P. Uellendahl M. de Souza A.C.C. de Jesus E.V.S. et al. SAVEME(myocardial salvage after rescue angioplasty: evaluation by magnetic resonance) study: rationale and study design. Rev. Brasil. Cardiol. Invasiva (English Edition). 2016; 24: 9-13 Crossref Scopus (2) Google Scholar ]. Proper management of these patients treated with rescue PCI remains challenging [ [4] de Souza M.T. Ybarra L.F. Oliveira T.P. Uellendahl M. de Souza A.C.C. de Jesus E.V.S. et al. SAVEME(myocardial salvage after rescue angioplasty: evaluation by magnetic resonance) study: rationale and study design. Rev. Brasil. Cardiol. Invasiva (English Edition). 2016; 24: 9-13 Crossref Scopus (2) Google Scholar ].