Impact of reperfusion timing and methods on myocardial structure and function in ST-segment elevation myocardial infarction

Aim. To compare the effectiveness of primary percutaneous coronary intervention (PPCI) and a pharmacoinvasive strategy (PIs) for revascularization, and to study the impact of their timing on the morphofunctional and electrophysiological myocardial characteristics in patients with ST-segment elevation myocardial infarction. Material and methods. A total of 185 patients aged 53±9 years were included. On days 7-10, patients underwent cardiac magnetic resonance imaging (MRI), speckletracking echocardiography, and Holter monitoring. Results. Subjects were divided into following groups: the early reperfusion (ER) group included 97 patients with an onset-to-revascularization time ≲180 minutes; and the delayed reperfusion (DR) group included 88 patients with an onset-to-revascularization time >180 minutes. According to MRI, scar tissue mass in the DR group was 24,7 (13,6; 42,9) g versus 15,9 (5,9; 30,7) g in the ER group (p=0,003). In the ER group, a more pronounced proportion of the heterogeneous area relative to the scar was observed compared to the DR group (p=0,018). The global contrast index in the ER group was 17,7 (10,3; 33,1)%, and in the DR group — 25 (16,2; 38,2)% (p=0,014). According to the echocardiography, lower values of global work efficiency with a simultaneous increase in global wasted work were revealed in the DR group (p180 min is associated with the most unfavorable characteristics of ischemic injury according to MRI, myocardial work according to speckle-tracking echocardiography, and Holter monitoring data. A comparative analysis of patients with PPCI and PIs performed in the first 180 minutes did not demonstrate differences in morphofunctional and electrophysiological myocardial characteristics.