Telemedicine as an instrument for cardiological consultation during the COVID-19 pandemic

Telemedicine is an underused instrument along our healthcare systems. It´s a technological tool that optimizes resources, save money, expands our capacities, decongests our traditional medical services and is an invaluable help for teaching and research. The COVID-19 pandemic is forcing us to expand its use and it gives us the opportunity to design an appropriate implementation.

P2711Prevalence of collateral circulation and its importance on the development of reperfusion injury in patients with acute myocardial infarction with ST-segment elevation

Introduction

In myocardial infarction with ST-segment elevation, early restoration of flow is the most important objective, but there is a possibility that reperfusion may induce ischemia-reperfusion injury. There is little information about the relationship of collateral circulation and reperfusion damage in patients with infarction, which is the reason for our study. Objective: To determine the prevalence of collateral circulation and its importance in the development of microvascular occlusion and intramyocardial hemorrhage evaluated by magnetic resonance imaging in patients with acute myocardial infarction with ST-segment elevation.

Methods

Observational, analytical study, retrospective cohort.

Methods

From March 2008 to April 2017, 359 patients were included and they were over 18 years of age with acute myocardial infarction with ST-segment elevation undergoing primary angioplasty who had magnetic resonance imaging. It was classified into 2 groups of patients: Group 1 (309 patients, without collateral circulation) and group 2 (50 patients, with collateral circulation). The presence or absence of collateral circulation was determined by coronary angiography and reperfusion injury (microvascular obstruction and intramyocardial hemorrhage) was evaluated by magnetic resonance. The x2 test was used to compare the categorical variables and the Mann-Whitney U test for continuous numerical variables.

Results

Of 359 patients, 50 (13.9%) patients had collateral circulation. The presence of reperfusion damage by magnetic resonance was compared. Patients in group 1 had reperfusion injury in 73.8% and group 2, 70.0% (p: 0.57).

Presence or absence of reperfusion injury in patients with and without collateral circulation No Collateral circulation Collateral circulation “p” value n=309 (%) n=50 (%) Reperfusion inury 0.57   No 81 (26.2%) 15 (30.0%)   Yes 228 (73.8%) 35 (70.0%) Microvascular Obstruction 0.59   No 81 (26.4%) 15 (30.0%)   Yes 226 (73.6%) 35 (70.0%) Myocardial Hemorrhage 0.24   No 189 (61.4%) 35 (70.0%)   Yes 119 (38.6%) 15 (30.0%)

Conclusions

In the present study it is demonstrated that the presence of collateral circulation did not influence the reperfusion damage, so the collateral circulation does not protect the myocardium from reperfusion injury. Prospective studies were needed to confirm this results.

Acknowledgement/Funding

Carlos Slim Fundation