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Updated: Apr 5, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Six-Year Prognostic Value of Microvascular Obstruction After Reperfused ST-Elevation Myocardial Infarction as
Matthias Regenfus1, Christian Schlundt1, Robert Krähner1
1Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Abstract:
Although recent studies showed the prognostic value of cardiac magnetic resonance (CMR) parameters especially microvascular obstruction (MO) after reperfused ST-elevation myocardial infarction (STEMI), a study assessing their prognostic significance for long-term follow-up is missing so far. The objective of this study was to determine the prognostic impact of MO on long-term prognosis after reperfused first STEMI in a setting allocating CMR-assessed parameters to hard clinical events only. In 249 patients, CMR was performed after reperfused STEMI, and hereby, left ventricular ejection fraction (LVEF), infarct size (IS), and the amount of MO were quantified. Follow-up (median 6.0 years) was obtained regarding occurrence of major adverse cardiac events (MACE). MACE occurred more often in patients showing presence of MO (MO vs no MO: n = 61 [54%] vs n = 12 [9%], p <0.0001). By multivariate analysis, the extent of MO remained the strongest predictor (p <0.001) for occurrence of MACE and provided incremental prognostic value over clinical variables and LVEF (p = 0.028, c-index increase from 0.723 to 0.817). In conclusion, CMR-assessed MO proves predictive for assessment of 6-year prognosis in patients after reperfused first STEMI and provides incremental prognostic information over clinical variables and LVEF in a setting based on hard end points.
Insights
Microvascular obstruction (MO) assessed by cardiac magnetic resonance (CMR) is a strong predictor of long-term major adverse cardiac events (MACE) after ST-elevation myocardial infarction (STEMI). This finding offers valuable prognostic information beyond traditional metrics.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Cardiac magnetic resonance (CMR) parameters, particularly microvascular obstruction (MO), show prognostic value post-ST-elevation myocardial infarction (STEMI).
- Long-term prognostic significance of CMR-assessed MO after reperfused STEMI requires further investigation.
Purpose of the Study:
- To determine the prognostic impact of MO on long-term outcomes.
- To assess the predictive value of MO for major adverse cardiac events (MACE) after reperfused first STEMI.
Main Methods:
- 249 patients underwent CMR post-reperfusion for STEMI.
- Quantified left ventricular ejection fraction (LVEF), infarct size (IS), and MO.
- Median 6.0-year follow-up for MACE occurrence.
Main Results:
- MACE occurred significantly more often in patients with MO (54%) compared to those without (9%).
- Extent of MO was the strongest independent predictor of MACE (p <0.001).
- MO provided incremental prognostic value over clinical variables and LVEF (c-index increase from 0.723 to 0.817).
Conclusions:
- CMR-assessed MO is predictive of 6-year prognosis in patients post-reperfusion for STEMI.
- MO offers incremental prognostic information beyond clinical variables and LVEF for hard endpoints.
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