Importance of infarct size versus other variables for clinical outcomes after PPCI in STEMI patients

  • Thomas Bochaton
  • Marc J. Claeys
  • David Garcia-Dorado
  • Nathan Mewton
  • Cyrille Bergerot
  • Claire Jossan
  • Camille Amaz
  • Inesse Boussaha
  • Hélène Thibault
  • Michel OvizeEmail author
Original Contribution


Despite promising experimental studies and encouraging proof-of-concept clinical trials, interventions aimed at limiting infarct size have failed to improve clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Our objective was to examine whether variables (cardiovascular risk factors, comorbidities, post-procedural variables, cotreatments) might be associated with clinical outcomes in STEMI patients independently from infarct size reduction. The present study was based on a post hoc analysis of the CIRCUS trial database ( NCT01502774) that assessed the clinical benefit of a single intravenous bolus of cyclosporine in 969 patients with anterior STEMI. Since cyclosporine had no detectable effect on clinical outcomes as well as on any measured variable, we here considered the whole study population as one group. Multivariate analysis was performed to address the respective weight of infarct size and variables in clinical outcomes. Multivariate analysis revealed that several variables (including gender, hypertension, renal dysfunction, TIMI flow grade post-PCI < 3, and treatment administered after PCI with betablockers and angiotensin-converting enzyme inhibitors) had per se a significant influence on the occurrence of [death or hospitalization for heart failure] at 1 year. The relative weight of infarct size and variables on the composite endpoint of [death or hospitalization for heart failure] at 1 year was 18% and 82%, respectively. Several variables contribute strongly to the clinical outcomes of STEMI patients suggesting that cardioprotective strategy might not only focus on infarct size reduction.


Cardio-protection Infarct size Comorbidities ischemia–reperfusion injury STEMI 



The CIRCUS study was supported by grants from the French Ministry of Health and Research National Program (Programme Hospitalier de Recherche Clinique National 2010) and NeuroVive Pharmaceutical. M. Ovize has been supported by the OPeRa (ANR-10-IBHU-0004 OPeRa) and the RHU MARVELOUS (ANR-16- RHUS-0009) programs.


David Garcia-Dorado is recipient of grants from ‘Instituto de Salud Carlos III’, the European Regional Development Fund (ERDF-FEDER), and European Union CARDIOPROTECTION COST Action (CA16225).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Thomas Bochaton
    • 1
  • Marc J. Claeys
    • 4
  • David Garcia-Dorado
    • 5
    • 6
  • Nathan Mewton
    • 1
  • Cyrille Bergerot
    • 1
    • 2
  • Claire Jossan
    • 2
  • Camille Amaz
    • 2
  • Inesse Boussaha
    • 2
  • Hélène Thibault
    • 1
    • 2
  • Michel Ovize
    • 1
    • 2
    • 3
    Email author
  1. 1.INSERM UMR 1060, CarMeN LaboratoryUniversity Claude Bernard Lyon1, IHU OPeRa, Hôpital Louis Pradel, Hospices Civils de LyonLyonFrance
  2. 2.Service d’Explorations Fonctionnelles Cardiovasculaires CIC 1407 de LyonHôpital Louis Pradel, Hospices Civils de LyonLyonFrance
  3. 3.Service d’Explorations Fonctionnelles CardiovasculairesHôpital Louis PradelBronFrance
  4. 4.Department of CardiologyAntwerp University HospitalAntwerpBelgium
  5. 5.Hospital Universitari Vall d´Hebron, Department of CardiologyVall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de BarcelonaBarcelonaSpain
  6. 6.Centro de Investigación Biomédica en Red-CVBarcelonaSpain

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