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Risk factor analysis of microvascular obstruction after percutaneous coronary intervention for ST-segment elevation
Jiali Wang1, Tianyu Geng2, Xiaole Li2
1Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, PR China; School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, PR China.
Insights
Delays in reperfusion therapy, specifically symptom onset to wire times exceeding 300 minutes, increase the risk of microvascular obstruction (MVO) after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Shorter ischemia times are crucial for better outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Microvascular obstruction (MVO) is a complication following percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI).
- Identifying risk factors for MVO is crucial for improving post-PCI outcomes.
Purpose of the Study:
- To investigate the risk factors associated with microvascular obstruction (MVO) after PCI in STEMI patients.
- To determine the impact of treatment delays on MVO occurrence.
Main Methods:
- Retrospective analysis of 165 STEMI patients undergoing emergency PCI and cardiac magnetic resonance (CMR) within one week.
- Comparison of ischemia times (Symptom Onset to Wire - S2W, First Medical Contact to Wire - FMC2W, Door to Wire - D2W) with critical time nodes.
- Evaluation of left ventricular function and myocardial infarction characteristics using CMR (cine and late-gadolinium enhancement - LGE).
- Binary logistic regression analysis to assess the effect of treatment delays on MVO.
Main Results:
- Microvascular obstruction (MVO) was present in 53.9% of STEMI patients post-PCI.
- Longer FMC2W and S2W times were significantly associated with MVO.
- Patients with MVO exhibited larger myocardial infarction size (IS) and lower left ventricular ejection fraction (LVEF).
- Symptom onset to wire (S2W) time exceeding 300 minutes was identified as an independent predictor of MVO (OR=2.756, P=0.039).
Conclusions:
- Shortening total myocardial ischemia time is essential for preventing or reducing MVO after PCI.
- Increasing the rate of early reperfusion therapy can mitigate MVO risk in STEMI patients.
Objective:
This study aimed to explore the risk factors of microvascular obstruction (MVO) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Methods:
A retrospective analysis was performed on 165 patients with STEMI who successfully underwent emergency PCI and completed cardiac magnetic resonance (CMR) within 1 week after PCI. Total ischemia time (symptom onset to wire, S2W), first medical contact to wire (FMC2W), and door to wire (D2W) were compared with the recommended critical time nodes for STEMI treatment. Left ventricular function was evaluated by CMR cine, and myocardial infarction characteristics and MVO were evaluated by late-gadolinium enhancement (LGE). Binary logistic regression analysis was used to evaluate the effect of delay in treatment of STEMI on the occurrence of MVO after PCI.
Results:
In this study, 89 (53.9%) patients with STEMI presented with MVO after emergency PCI. The FMC2W time and S2W time in the MVO (+) group were significantly longer than those in the MVO (-) group (P < 0.05). Compared with the MVO (-) group, the MVO (+) group had larger myocardial infarction size (IS) and lower left ventricular ejection fraction (LVEF) (P < 0.05). Patients with FMC2W time >120 min and S2W time >300 min had greater myocardial IS and MVO than the FMC2W ≤ 120 min and S2W time ≤300 min group, respectively. Logistic regression analysis showed that S2W time >300 min (P = 0.039, OR = 2.756, 95% CI = 1.053-7.213) was an independent predictor of MVO after PCI in patients with STEMI.
Conclusion:
Shortening the total time of myocardial ischemia and increasing the proportion of early reperfusion therapy can prevent or reduce MVO after PCI.
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