Limitation of infarct size by fixed coronary arterial stenosis maintained during reperfusion.

BACKGROUND: The effect on infarct size of a pre-infarction high-grade, fixed coronary arterial stenosis maintained during reperfusion, was evaluated. METHODS: This experimental study was carried out in the research laboratory of a University Hospital. A canine occlusion-reperfusion model was used. Twenty-eight dogs underwent proximal left anterior descending (LAD) coronary artery occlusion (O). In Group 1 (n=6) the O lasted for 6 hours. In Group 2 (n=6) the O lasted for 2 hours followed by 4 hours of reperfusion (R). In Group 3 (n=3), LAD was stenosed for 30 minutes followed by O for 6 hours. In Group 4 (n=7) LAD was stenosed for 30 minutes followed by O for 2 hours and then 4 hours of R during which the artery was kept stenosed at the same degree (fixed) as the initial one. In Group 5 (n=6) the protocol was identical to Group 4 with the additional use of the intra-aortic balloon pump during R. RESULTS: The infarcted myocardium was almost the same in Groups 1 and 3 (80.0+/-10.6% vs 77.3+/-3.8%, respectively, p=NS), but less in Group 2 (59.0+/-19.9%, p=0.046 vs Group 1). There were no hemodynamic differences between Groups 4 and 5 and the infarcted myocardium was almost identical in both groups (37.7+/-18.8% and 38.7+/-19.1%, respectively, p=NS). The combined results of Groups 4 and 5, regarding the infarcted myocardium, was 38.1+/-18% (p=0.037 vs Group 2). CONCLUSIONS: In this acute coronary occlusion model, a pre-existing high-grade stenosis that maintained during reperfusion increased the amount of salvaged ischemic myocardium.

Myocardial salvage by the use of reperfusion and intraaortic balloon pump: experimental study.

BACKGROUND: Thrombolytic therapy improves left ventricular ejection fraction and survival. The study was undertaken to evaluate the effects of intraaortic balloon pump used in conjunction with reperfusion in reducing infarct size. METHODS: Twenty-two dogs were subjected to proximal left anterior descending coronary artery occlusion. In group 1 (n = 7) occlusion lasted for 6 hours. In group 2 (n = 6) 2 hours of occlusion was followed by reperfusion. In group 3 (n = 9) after 2 hours of occlusion the dogs were assisted with the intraaortic balloon pump throughout the 4 hours of reperfusion. At the end of 6 hours the infarcted myocardium of the left ventricle was determined and expressed as percentage of the myocardium at risk. RESULTS: In group 1, the infarcted myocardium was 79.3 +/- 9.9% of the myocardium at risk, in group 2, 59.0 +/- 19.9% (p < 0.05 versus group 1), and in group 3, 37.1 +/- 16.7% (p < 0.001 versus group 1 and p < 0.05 versus group 2). Endocardial viability ratio was increased by the intraaortic balloon pump; in group 1 it was 1.02 +/- 0.14, in group 2, 1.25 +/- 0.24, and in group 3, 1.47 +/- 0.31 (p < 0.001 versus group 1 and p < 0.02 versus group 2). CONCLUSIONS: Reperfusion and intraaortic balloon pump increased salvage of the ischemic myocardium over that achieved by reperfusion alone in a canine occlusion-reperfusion model.