Outcome measures and follow-up
ventricular mass, microvascular obstruction, coronary artery injury, arrhythmia, edema, myocardial salvage, infarct
PULMONARY EMBOLISM, ARRHYTHMIA, EDEMA, SCAR, HEART, INFARCT
A cardiologist visited the patients daily during hospitalization. A physical examination was conducted, and vital signs were noted. The patients were monitored for indicators of arrhythmia, pulmonary embolism, and coronary artery injury. Baseline tests including fasting blood sugar (FBS), complete cell blood count (CBC), urea and electrolytes, liver function tests (LFTs), creatine kinase, and cardiac troponin T and C reactive protein were also requested. A standard 12-lead electrocardiogram (ECG) was also taken. LV function was first evaluated via echocardiography, with the EF being calculated using the motion score and Simpson’s rule. The global longitudinal strain (GLS) was also measured with automated formulas in standard views. Cardiac magnetic resonance (CMR) imaging was done 3 days after primary PCI. Cine-CMR evaluated ventricular function and volume, delayed enhancement (DE)-CMR determined microvascular obstruction and infarct size, and T2 imaging assessed myocardial salvage and infarct size. Myocardial nulling was optimized according to the inversion time. Scar and edema volumes were manually traced with endocardial and epicardial contours after the semi-automated selection of the normal remote myocardium per slice. Images were assessed by an expert operator who was blinded to the study group allocations.All patients were discharged with a beta-blocker, angiotensin-converting enzyme (ACE) inhibitor, aldosterone antagonist, aspirin, ticagrelor, statin, nitrates (as needed), and a cardiac rehabilitation program. The physical examination, blood tests, and ECG were repeated on day 10 and after 3 and 6 months. Echocardiography and CMR were repeated after 6 months. Follow-up visits were at Imam Reza Clinic (Shiraz, Iran) or the outpatient cardiology clinic of Al-Zahra Heart Hospital (Shiraz, Iran).The primary outcomes were both safety and the LVEF improvement after 6 months. Secondary outcomes included the 6-month CMR-recorded change in the infarct area and echographic changes in LV function, left ventricular mass (LVM), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESD), and GLS.