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Temporal Trends in Infarct Severity Outcomes in ST-Segment-Elevation Myocardial Infarction: A Cardiac Magnetic
Ivan Lechner1, Martin Reindl1, Christina Tiller1
1University Clinic of Internal Medicine III, Cardiology and Angiology Medical University of Innsbruck Innsbruck Austria.
Insights
Despite advancements in treatment for ST-segment-elevation myocardial infarction (STEMI), cardiac magnetic resonance imaging shows no significant change in myocardial infarct size or severity over 15 years. Further research into novel therapies is crucial to reduce heart tissue damage.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Myocardial tissue injury severity significantly impacts morbidity and mortality in ST-segment-elevation myocardial infarction (STEMI).
- Temporal trends in myocardial infarct characteristics at the tissue level remain undescribed.
- Cardiac magnetic resonance imaging (CMR) provides comprehensive assessment of myocardial tissue injury.
Purpose of the Study:
- To assess temporal trends in infarct characteristics using CMR at a standardized early time point after STEMI.
- To evaluate changes in infarct size, microvascular obstruction, and intramyocardial hemorrhage over time.
- To investigate long-term outcomes and left ventricular remodeling in STEMI patients.
Main Methods:
- Analysis of 843 STEMI patients treated with percutaneous coronary intervention (PCI) between 2005 and 2021.
- Utilized a multiparametric CMR protocol within the first week post-STEMI.
- Compared infarct characteristics and clinical outcomes across three study period terciles.
Main Results:
- No significant changes observed in infarct size (P=0.25), microvascular obstruction (P=0.50), or intramyocardial hemorrhage (P=0.34) over the study period.
- Left ventricular remodeling indices and ejection fraction remained unchanged (all P>0.05).
- Major adverse cardiovascular events at 4 months were similar across groups (P=0.36).
Conclusions:
- Despite advancements in PCI and guideline-recommended therapies, myocardial infarct severity has not improved over the past 15 years.
- Current therapeutic approaches may not be sufficient to reduce myocardial tissue injury in STEMI.
- Prioritizing clinical research for novel therapeutic strategies to mitigate myocardial damage is essential.
Abstract:
Background Severity of myocardial tissue injury is a main determinant of morbidity and death related to ST-segment-elevation myocardial infarction (STEMI). Temporal trends of infarct characteristics at the myocardial tissue level have not been described. This study sought to assess temporal trends in infarct characteristics through a comprehensive assessment by cardiac magnetic resonance imaging at a standardized time point early after STEMI. Methods and Results We analyzed patients with STEMI treated with percutaneous coronary intervention at the University Hospital of Innsbruck who underwent cardiac magnetic resonance imaging between 2005 and 2021. The study period was divided into terciles. Myocardial damage characteristics were assessed using a multiparametric cardiac magnetic resonance imaging protocol within the first week after STEMI and compared between groups. A total of 843 patients with STEMI (17% women) with a median age of 57 (interquartile range, 51-66) years were analyzed. While age, sex, and the clinical risk profile expressed as thrombolysis in myocardial infarction risk score were comparable across the study period, there were differences in guideline-recommended therapies. At the same time, there was no significant change in infarct size (P=0.25), microvascular obstruction (P=0.50), and intramyocardial hemorrhage (P=0.34). Left ventricular remodeling indices and left ventricular ejection fraction remained virtually unchanged (all P>0.05). Major adverse cardiovascular events at 4 (interquartile range, 4-5) months were similar between groups (P=0.36). Conclusions In this magnetic resonance imaging study investigating patients with STEMI treated with primary percutaneous coronary intervention over the past 15 years, no change in infarct severity at the myocardial level has been observed. Clinical research on novel therapeutic approaches to reduce myocardial tissue injury should be a priority.
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