Persistent Microvascular Obstruction late after STEMI is associated with Adverse Events:Insights from a Cardiac Magnetic Resonance Study

Zielsetzung The presence of microvascular obstruction (MVO) in acute ST-elevation myocardial infarction (STEMI) has significant prognostic implications. However, data about the prevalence and clinical relevance of persistent MVO late after acute STEMI are lacking. This study aims to evaluate the association of persistent MVO to adverse events and adverse left ventricular (LV) remodelling after STEMI.

Material und Methoden In total, 627 patients with first-time STEMI underwent sequential cardiac magnetic resonance imaging (CMR) 4 days, 4 months and 12 months after infarction to assess the presence of MVO, infarct size and myocardial function. Adverse LV remodelling was defined as an increase of≥20% of the end-diastolic volume at 12 months after STEMI. Major adverse clinical events (MACE) were defined as composite of death, re-infarction and new congestive heart failure within 12 months.

Ergebnisse Baseline MVO was present in 381 patients (61%) and persisted in 36 patients (10%) at 4-months CMR and in 21 patients (6%) at 12-months CMR. Compared to patients without baseline MVO, acute MVO was associated to adverse LV remodelling (15% vs. 6%, p<.001) and to the occurrence of MACE (11% vs. 6%, p=.027) at 12 months follow up. Within MVO-patients, those with persistent MVO ≥4 months after STEMI had a higher frequency of MACE (20% vs. 8%,p=.021). In logistic regression analysis, the persistence of MVO ≥4 months after STEMI was significantly associated with MACE (OR: 3.3 (95% confidence interval: 1.4-7.6, p=.005)).

Schlussfolgerungen Persistence of MVO beyond the acute phase after STEMI occurs in ≤10% of patients with baseline MVO and is linked to the occurrence of MACE and adverse LV remodelling.

 

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Artikel online veröffentlicht:
12. April 2024