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Predictors of Intramyocardial Hemorrhage After Reperfused ST-Segment Elevation Myocardial Infarction
Raquel P Amier1, Ruben Y G Tijssen1, Paul F A Teunissen1
1Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
Insights
Intramyocardial hemorrhage (IMH) occurs in over half of ST-segment elevation myocardial infarction (STEMI) patients and is linked to anterior infarction and specific treatments. IMH indicates more severe heart attacks and poorer short-term function.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Microvascular injury in myocardial infarction includes intramyocardial hemorrhage (IMH).
- IMH presence in ST-segment elevation myocardial infarction (STEMI) correlates with worse patient prognoses.
- Predictors for IMH occurrence post-STEMI remain poorly understood.
Purpose of the Study:
- To determine the prevalence and extent of IMH in STEMI patients.
- To identify clinical and periprocedural predictors associated with IMH occurrence and severity.
- To explore the relationship between IMH and infarct characteristics.
Main Methods:
- A multicenter observational cohort study involving 410 successfully reperfused STEMI patients.
- Cardiovascular magnetic resonance imaging (CMR) assessed microvascular obstruction and IMH.
- IMH presence and extent were analyzed against clinical and periprocedural variables.
Main Results:
- 54% of STEMI patients exhibited IMH.
- IMH presence was independently associated with anterior infarction and glycoprotein IIb/IIIa inhibitor use.
- Extensive IMH was significantly linked to anterior infarction.
- IMH correlated with larger infarct size, greater microvascular obstruction, and impaired left ventricular function.
Conclusions:
- Anterior infarction and glycoprotein IIb/IIIa inhibitor treatment are predictors of IMH in STEMI.
- Extensive IMH is specifically associated with anterior infarction.
- IMH signifies more severe myocardial infarction and worse short-term left ventricular function.
Background:
Findings from recent studies show that microvascular injury consists of microvascular destruction and intramyocardial hemorrhage (IMH). Patients with ST-segment elevation myocardial infarction (STEMI) with IMH show poorer prognoses than patients without IMH. Knowledge on predictors for the occurrence of IMH after STEMI is lacking. The current study aimed to investigate the prevalence and extent of IMH in patients with STEMI and its relation with periprocedural and clinical variables.
Methods And Results:
A multicenter observational cohort study was performed in patients with successfully reperfused STEMI with cardiovascular magnetic resonance examination 5.5±1.8 days after percutaneous coronary intervention. Microvascular injury was visualized using late gadolinium enhancement and T2-weighted cardiovascular magnetic resonance imaging for microvascular obstruction and IMH, respectively. The median was used as the cutoff value to divide the study population with presence of IMH into mild or extensive IMH. Clinical and periprocedural parameters were studied in relation to occurrence of IMH and extensive IMH, respectively. Of the 410 patients, 54% had IMH. The presence of IMH was independently associated with anterior infarction (odds ratio, 2.96; 95% CI, 1.73-5.06 [P<0.001]) and periprocedural glycoprotein IIb/IIIa inhibitor treatment (odds ratio, 2.67; 95% CI, 1.49-4.80 [P<0.001]). Extensive IMH was independently associated with anterior infarction (odds ratio, 3.76; 95% CI, 1.91-7.43 [P<0.001]). Presence and extent of IMH was associated with larger infarct size, greater extent of microvascular obstruction, larger left ventricular dimensions, and lower left ventricular ejection fraction (all P<0.001).
Conclusions:
Occurrence of IMH was associated with anterior infarction and glycoprotein IIb/IIIa inhibitor treatment. Extensive IMH was associated with anterior infarction. IMH was associated with more severe infarction and worse short-term left ventricular function in patients with STEMI.
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