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Intramyocardial Hemorrhage in Patients with Acute Myocardial Infarction Without Reperfusion Therapy: A Prospective
Muzheng Li1, Zhijian Wu2, Ilyas Tudahun3
1Department of Cardiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518107, People's Republic of China.
Insights
Myocardial hemorrhage (IMH) occurs in ST-elevation myocardial infarction (STEMI) patients even without reperfusion therapy, with a higher incidence than in non-ST-elevation myocardial infarction (NSTEMI) patients. This finding is crucial for understanding acute myocardial infarction (AMI) complications.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Acute Myocardial Infarction
Background:
- Myocardial hemorrhage (IMH) is often associated with reperfusion therapy in ST-elevation myocardial infarction (STEMI).
- The occurrence of IMH in acute myocardial infarction (AMI) patients without reperfusion therapy remains unclear.
- Understanding IMH in non-reperfusion settings is critical for comprehensive patient management.
Purpose of the Study:
- To investigate the incidence and characteristics of IMH in patients with STEMI and NSTEMI who did not receive reperfusion therapy.
- To compare the incidence of IMH between STEMI and NSTEMI patients in the absence of reperfusion.
- To explore the relationship between IMH and major adverse cardiovascular events (MACE) in STEMI patients without reperfusion.
Main Methods:
- Prospective enrollment of 40 STEMI and 41 NSTEMI patients who did not undergo reperfusion therapy.
- Cardiac Magnetic Resonance (CMR) imaging to detect IMH.
- Comparison of IMH incidence between STEMI and NSTEMI groups.
- Analysis of MACE in STEMI patients with and without IMH.
Main Results:
- IMH was detected in 16 out of 40 STEMI patients (40%) and 3 out of 41 NSTEMI patients (7.3%), P < 0.001.
- The incidence of IMH in STEMI patients was comparable regardless of whether they underwent primary percutaneous coronary intervention (16/40) or not (27/65), P = 0.876.
- STEMI patients with IMH showed a trend towards higher MACE (5/16) compared to those without IMH (2/24), P = 0.063.
Conclusions:
- Myocardial hemorrhage (IMH) occurs in STEMI patients even without reperfusion therapy.
- The incidence of IMH is significantly higher in STEMI compared to NSTEMI patients, irrespective of reperfusion status.
- IMH in STEMI patients, even without restored infarct-related vessel flow, may be associated with adverse outcomes.
Background And Aims:
IMH commonly presents in STEMI patients receiving reperfusion therapy and is considered as an ischemic reperfusion injury. However, it is unclear whether IMH occurs in AMI patients without reperfusion therapy.
Methods And Results:
We prospectively enrolled 40 patients with STEMI and 41 patients with NSTEMI admitted to the CCU of the Second Xiangya Hospital of Central South University from April 2020 to November 2021, all of whom did not receive reperfusion therapy. In the STEMI group, 16 patients were detected with IMH by CMR. However, in the NSTEMI group, only 3 patients were detected. The incidence of IMH was significantly higher in patients with STEMI than NSTEMI (16/40 vs 3/41, P < 0.001). Among patients with STEMI, the incidence of IMH was not significantly different between patients who underwent primary percutaneous coronary intervention and those who did not (16/40 vs 27/65, P = 0.876). Patients in the spontaneous reperfusion group had a higher incidence of IMH than patients in the non-spontaneous reperfusion group (11/23 vs 5/17, P = 0.240). Similarly, in patients with STEMI who did not receive reperfusion therapy, the incidence of MACE was higher in the IMH-present group than in the IMH-absent group (5/16 vs 2/24, P = 0.063).
Conclusion:
The incidence of IMH is comparable in patients with STEMI with or without reperfusion therapy, but considerably higher than that in NSTEMI patients. Patients with STEMI can present with IMH even when infarct-related vessel flow is not restored.
