Myocardial salvage after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction presenting early versus late after symptom onset

  • Thomas Stiermaier
  • Ingo Eitel
  • Suzanne de Waha
  • Janine Pöss
  • Georg Fuernau
  • Holger Thiele
  • Steffen Desch
Original Paper


Primary percutaneous coronary intervention (PCI) is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) presenting within 12 h of symptom onset. A benefit in the subacute stage is less clear. The aim of the present analysis was to compare myocardial salvage and infarct size between patients with early and late reperfusion after STEMI. We compared cardiac magnetic resonance (CMR) data from a randomized controlled trial (RCT) in STEMI patients presenting within 12 h (n = 695) and a RCT of subacute STEMI patients presenting between 12 and 48 h (n = 93) after symptom onset. CMR imaging was performed 3.9 ± 6.3 days after myocardial infarction. Analyses were performed for an unmatched cohort comprising all patients (n = 788) and a cohort matched for area at risk (n = 186). In the overall cohort, area at risk was similar in both groups [37.1 ± 16.1% of left ventricular mass (%LV) vs. 38.3 ± 16.2%LV; p = 0.50]. Compared to STEMI patients with early reperfusion, patients with late PCI demonstrated larger infarct size (18.0 ± 12.5%LV vs. 28.9 ± 16.9%LV; p < 0.01) and higher extent of microvascular obstruction (1.5 ± 2.9%LV vs. 2.7 ± 4.1%LV; p = 0.01). Myocardial salvage index was significantly smaller in patients with late reperfusion (52.1 ± 25.9 vs. 27.4 ± 26.0; p < 0.01). Analysis of the matched cohorts confirmed the decreased myocardial salvage (p < 0.01) and increased infarct size (p < 0.01) in case of late reperfusion. Compared to patients with timely primary PCI, late reperfusion after STEMI results in decreased myocardial salvage and increased infarct size. However, salvageable myocardium was also found in subacute stages of STEMI.


ST-elevation myocardial infarction Cardiac magnetic resonance imaging Myocardial salvage Late reperfusion 



Area at risk


Cardiac magnetic resonance


Infarct size


Percentage of left ventricular mass


Microvascular obstruction


Myocardial salvage


Myocardial salvage index


Percutaneous coronary intervention


Randomized controlled trial


Single photon emission computed tomography


ST-elevation myocardial infarction


Thrombolysis in myocardial infarction


Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Thomas Stiermaier
    • 1
    • 2
  • Ingo Eitel
    • 1
    • 2
  • Suzanne de Waha
    • 1
    • 2
  • Janine Pöss
    • 1
    • 2
  • Georg Fuernau
    • 1
    • 2
  • Holger Thiele
    • 1
    • 2
  • Steffen Desch
    • 1
    • 2
  1. 1.University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine)University Hospital Schleswig-HolsteinLübeckGermany
  2. 2.German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/LübeckLübeckGermany

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