Related Experiment Video
Updated: Mar 27, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular
David Carrick1, Caroline Haig1, Nadeem Ahmed1
1From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (D.C., N.A., I.M., S.R., N.S., P.W., A.R., K.G.O., C.B.) and Robertson Centre for Biostatistics (C.H., I.F.), University of Glasgow, Glasgow, United Kingdom; Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., M.M., M.C.P., H.E., S.H., S.W., M.M.L., A.D., A.M., C.B.).
Insights
Myocardial hemorrhage after ST-segment-elevation myocardial infarction (MI) is linked to worse outcomes and adverse remodeling. This finding suggests hemorrhage is a stronger predictor of poor prognosis than microvascular obstruction.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Science
Background:
- Coronary reperfusion therapy for ST-segment-elevation myocardial infarction (MI) is often limited by impaired microvascular perfusion.
- Assessing myocardial hemorrhage and microvascular obstruction is crucial for understanding post-MI outcomes.
Purpose of the Study:
- To investigate the time course of myocardial hemorrhage and microvascular obstruction post-MI.
- To determine the association of myocardial hemorrhage and microvascular obstruction with adverse remodeling and clinical outcomes.
Main Methods:
- Prospective cohort study involving cardiac magnetic resonance imaging in patients with ST-segment-elevation MI.
- Serial imaging was performed at multiple time points (4 hours to 7 months) post-reperfusion.
- Myocardial hemorrhage was identified by T2* values, and microvascular obstruction by late gadolinium enhancement.
Main Results:
- Myocardial hemorrhage was observed in a significant proportion of patients, peaking on day 2 post-MI.
- Myocardial hemorrhage was associated with adverse remodeling (OR: 2.64; P=0.035).
- Myocardial hemorrhage, not microvascular obstruction, was significantly associated with adverse clinical outcomes (HR: 5.89; P=0.025).
Conclusions:
- Myocardial hemorrhage and microvascular obstruction exhibit distinct temporal patterns after ST-segment-elevation MI.
- Myocardial hemorrhage is a stronger predictor of adverse outcomes compared to microvascular obstruction.
Background:
The success of coronary reperfusion therapy in ST-segment-elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion.
Methods And Results:
We performed a prospective cohort study in patients with reperfused ST-segment-elevation MI who underwent cardiac magnetic resonance 2 days (n=286) and 6 months (n=228) post MI. A serial imaging time-course study was also performed (n=30 participants; 4 cardiac magnetic resonance scans): 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value of <20 ms. Microvascular obstruction was assessed with late gadolinium enhancement. Adverse remodeling was defined as an increase in left ventricular end-diastolic volume ≥20% at 6 months. Cardiovascular death or heart failure events post discharge were assessed during follow-up. Two hundred forty-five patients had evaluable T2* data (mean±age, 58 [11] years; 76% men). Myocardial hemorrhage 2 days post MI was associated with clinical characteristics indicative of MI severity and inflammation. Myocardial hemorrhage was a multivariable associate of adverse remodeling (odds ratio [95% confidence interval]: 2.64 [1.07-6.49]; P=0.035). Ten (4%) patients had a cardiovascular cause of death or experienced a heart failure event post discharge, and myocardial hemorrhage, but not microvascular obstruction, was associated with this composite adverse outcome (hazard ratio, 5.89; 95% confidence interval, 1.25-27.74; P=0.025), including after adjustment for baseline left ventricular end-diastolic volume. In the serial imaging time-course study, myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. The amount of hemorrhage (median [interquartile range], 7.0 [4.9-7.5]; % left ventricular mass) peaked on day 2 (P<0.001), whereas microvascular obstruction decreased with time post reperfusion.
Conclusions:
Myocardial hemorrhage and microvascular obstruction follow distinct time courses post ST-segment-elevation MI. Myocardial hemorrhage was more closely associated with adverse outcomes than microvascular obstruction.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Myocarditis I: Introduction