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Clinical Impact of Persistent Microvascular Obstruction in CMR After Reperfused STEMI
Felix Troger1, Mathias Pamminger1, Paulina Poskaite1
1University Clinic of Radiology, Medical University of Innsbruck, Austria (F.T., M.P., P.P., M.S., B.H., A.M.).
Background:
Microvascular injury in the course of acute ST-segment-elevation myocardial infarction (STEMI) has been identified as determinant of adverse outcomes and manifests as microvascular obstruction (MVO). MVO has long been regarded as a transient finding, vanishing within a few weeks after infarction. However, recent studies have shown that it may persist beyond the early phase, resulting in adverse remodeling. However, its clinical implications remain unclear. This study aims to evaluate the association of MVO persistence and major adverse cardiac events after STEMI.
Methods:
In total, 609 patients with revascularized first-time STEMI underwent cardiac magnetic resonance imaging (CMR) at 4 days, 4 months, and 12 months after STEMI to assess MVO, infarct size, and left ventricular function. Major adverse cardiac events were defined as composite of death, reinfarction, and new congestive heart failure within a median interval of 3.2 years.
Results:
Baseline MVO was present in 365 (60%) patients and persisted in 35 (10%) patients at 4-month CMR and in 20 (5%) patients at 12-month CMR. Compared with transient MVO not present at follow-up, patients with MVO persistence ≥4 months were more likely to experience major adverse cardiac events during follow-up (29% versus 13%; P=0.016). Within patients with MVO, those with MVO persistence had lower left ventricular ejection fraction (P=0.002), larger infarcts (P=0.00001), and more frequent intramyocardial hemorrhage (P=0.001) at baseline CMR.
Conclusions:
Persistent MVO after STEMI occurs in up to 10% of patients with baseline MVO and is linked to major adverse cardiac events. Patients with MVO persistence had larger infarcts, lower left ventricular function, and more frequent intramyocardial hemorrhage at baseline CMR. All patients with MVO persisting ≥12 months initially showed intramyocardial hemorrhage.
Insights
Persistent microvascular obstruction (MVO) after ST-segment-elevation myocardial infarction (STEMI) is linked to major adverse cardiac events. This MVO persistence, seen in up to 10% of patients, indicates poorer outcomes and requires further investigation.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Infarction Research
Background:
- Microvascular injury, manifesting as microvascular obstruction (MVO), is a key factor in adverse outcomes following acute ST-segment-elevation myocardial infarction (STEMI).
- While traditionally considered transient, MVO can persist post-STEMI, potentially leading to adverse cardiac remodeling, though its long-term clinical implications are not fully understood.
Purpose of the Study:
- To investigate the association between the persistence of microvascular obstruction (MVO) and the occurrence of major adverse cardiac events (MACE) in patients after ST-segment-elevation myocardial infarction (STEMI).
Main Methods:
- A cohort of 609 patients with first-time STEMI underwent cardiac magnetic resonance imaging (CMR) at 4 days, 4 months, and 12 months post-STEMI.
- CMR assessed MVO, infarct size, and left ventricular function. Major adverse cardiac events were tracked for a median of 3.2 years.
Main Results:
- Microvascular obstruction (MVO) was initially present in 60% of patients and persisted at 12 months in 5% of those with baseline MVO.
- Patients with MVO persistence at 4 months had a significantly higher rate of major adverse cardiac events (29% vs. 13%, P=0.016) compared to those with transient MVO.
- Persistent MVO was associated with larger infarct size, reduced left ventricular ejection fraction, and more frequent intramyocardial hemorrhage at baseline.
Conclusions:
- Persistent microvascular obstruction (MVO) after ST-segment-elevation myocardial infarction (STEMI) is identified in up to 10% of patients with initial MVO and is a significant predictor of major adverse cardiac events.
- The presence of persistent MVO is linked to adverse baseline characteristics, including larger infarcts, impaired left ventricular function, and intramyocardial hemorrhage.
- All patients with MVO persisting for at least 12 months showed evidence of intramyocardial hemorrhage at baseline, suggesting a severe injury pattern.
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