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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Prognostic Value of Persistent Microvascular Obstruction on Follow-Up Cardiac MRI After Reperfused STEMI
Pengyu Zhou1, Fen Sa1, Kaisaierjiang Aisikaier1
1Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background:
The prognostic value of persistent microvascular obstruction (persistent-MVO) in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI) remains unclear.
Objectives:
To investigate the prognostic value of persistent-MVO in reperfused STEMI.
Methods:
Retrospectively analyzed 504 STEMI patients with primary PCI who underwent a follow-up cardiac magnetic resonance at ≥60 days after PCI. Persistent-MVO was defined as the presence of MVO on late gadolinium enhancement (LGE) imaging, which served as the study baseline. The endpoint was composite events of heart failure (HF), including HF-related death, heart transplantation, left ventricular assist device implantation, and HF hospitalization. Competing risk analysis was performed to address the possible influences of competing events.
Results:
Persistent-MVO was detected in 44 of 504 patients (8.7%). These patients demonstrated lower left ventricular ejection fraction, larger end-diastolic volume index, and larger LGE extent (all P < 0.05), compared with those without. During a median follow-up of 64.5 months (IQR: 45.0-79.4), 91 of 504 patients (18.1%) experienced the endpoint. Adding persistent-MVO to a model with NYHA functional class, left ventricular ejection fraction, and LGE extent improved model discrimination (C-index: from 0.78 [95% CI: 0.73-0.83] to 0.82 [95% CI: 0.77-0.86], P = 0.01), model fit (-2 log-likelihood: from 996.7 to 984.8, P < 0.001), and risk reclassification (continuous net reclassification improvement: 8.56% [95% CI: 2.60%-16.23%], P < 0.01), with decision curve analysis confirming net clinical benefit at 5 years.
Conclusions:
Persistent-MVO was observed in 8.7% of STEMI patients at least 60 days after PCI and provided incremental value beyond established risk markers for predicting HF-related events.
Insights
Persistent microvascular obstruction (MVO) after ST-segment elevation myocardial infarction (STEMI) treatment predicts heart failure events. This finding offers incremental value beyond existing risk markers for STEMI patients post-percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- The prognostic significance of persistent microvascular obstruction (MVO) in ST-segment elevation myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI) is not well-established.
- Understanding MVO's impact is crucial for risk stratification and management strategies.
Purpose of the Study:
- To evaluate the prognostic value of persistent MVO in patients with reperfused STEMI.
- To determine if persistent MVO predicts adverse cardiovascular outcomes.
Main Methods:
- Retrospective analysis of 504 STEMI patients undergoing primary PCI.
- Follow-up cardiac magnetic resonance (CMR) at ≥60 days post-PCI to assess persistent MVO using late gadolinium enhancement (LGE).
- Composite endpoint of heart failure (HF) events, including HF-related death, transplantation, LVAD implantation, and HF hospitalization, analyzed using competing risk models.
Main Results:
- Persistent MVO was identified in 8.7% of STEMI patients.
- Patients with persistent MVO had significantly lower left ventricular ejection fraction, larger end-diastolic volume index, and greater LGE extent.
- Persistent MVO improved the predictive model for HF events, enhancing discrimination, fit, and risk reclassification (C-index increased from 0.78 to 0.82).
Conclusions:
- Persistent MVO is present in a notable subset of STEMI patients at ≥60 days post-PCI.
- Persistent MVO serves as an independent predictor of HF-related events.
- Incorporating persistent MVO into risk models offers incremental prognostic value for STEMI patients.
