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Relationship between microvascular obstruction and adverse events following primary percutaneous coronary

Suzanne de Waha1,2, Manesh R Patel3, Christopher B Granger3

  • 1University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Luebeck, Germany.

European Heart Journal
|October 12, 2017
PubMed
Abstract

Insights

Microvascular obstruction (MVO) after ST-segment elevation myocardial infarction (STEMI) is linked to higher mortality and heart failure hospitalizations. Early assessment of MVO using cardiac magnetic resonance imaging (CMR) can predict patient outcomes within one year.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Research

Background:

  • Microvascular obstruction (MVO) is a key factor in the no-reflow phenomenon following ST-segment elevation myocardial infarction (STEMI).
  • The prognostic significance of MVO, particularly when assessed early via cardiac magnetic resonance imaging (CMR), requires further clarification.

Purpose of the Study:

  • To investigate the association between early MVO assessment by CMR and clinical outcomes in STEMI patients post-primary percutaneous coronary intervention (PCI).
  • Specifically, to determine the relationship between MVO and all-cause mortality, heart failure (HF) hospitalization, and reinfarction.

Main Methods:

  • A pooled analysis of individual patient data from seven randomized primary PCI trials was conducted.
  • MVO was assessed using CMR with late gadolinium enhancement within 7 days of reperfusion in 1688 STEMI patients.
  • Clinical follow-up data for at least 6 months post-event were analyzed.

Main Results:

  • Microvascular obstruction was identified in 56.9% of patients, with a median extent of 0.47% of left ventricular myocardial mass.
  • A significant, graded association was observed between the extent of MVO and increased risk of all-cause mortality (HR 1.14) and HF hospitalization (HR 1.08).
  • MVO remained a significant predictor of mortality even after adjusting for infarct size, but was not significantly associated with reinfarction.

Conclusions:

  • The presence and extent of MVO, as measured by CMR shortly after primary PCI in STEMI, are robustly associated with increased mortality and HF hospitalization within one year.
  • Early CMR assessment of MVO provides valuable prognostic information for STEMI patients.
Keywords:
Microvascular obstructionNo-reflow phenomenonPrimary percutaneous coronary interventionPrognosisST-segment elevation myocardial infarction

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