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Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction.
- Source :
-
European radiology [Eur Radiol] 2019 May; Vol. 29 (5), pp. 2369-2377. Date of Electronic Publication: 2018 Dec 14. - Publication Year :
- 2019
-
Abstract
- Objectives: To investigate the prognostic role of early post-infarction cardiac magnetic resonance (CMR) on long-term risk stratification of ST segment elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF).<br />Methods: Seventy-seven STEMI patients treated by primary percutaneous coronary intervention (PCI) and LVEF > 50% at CMR were included. The median time between STEMI and CMR was 5 days (IQR 2-8). LV volumes and function, area at risk (on T2 weighted images), infarcted myocardium (on late enhanced images), intramyocardial hemorrhage, and early and late microvascular obstruction (MVO) were detected and measured. CMR tissue determinants were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up.<br />Results: During median follow-up of 4 years (range 3 to 5 years), eight (10%) patients experienced MACE, yielding an annualized event rate of 2.1%. All CMR tissue markers were not significantly different between MACE and no-MACE patients, except for the presence of late MVO (50% vs. 16%, respectively; p = 0.044) and its extent (2.30 ± 1.64 g vs. 0.18 ± 0.12 g, respectively; p = 0.000). From receiver-operating characteristic (ROC) curve (area under the curve 0.89; 95% confidence interval, 0.75-1.0; p = 0.000), late MVO extent > 0.385 g was a strong independent predictor of MACE at long-term follow-up (sensitivity = 87%, specificity = 90%; hazard ratio = 2.24; 95% confidence interval, 1.51-3.33; p = 0.000).<br />Conclusions: Late MVO extent after primary PCI on CMR seems to be a strong predictor of MACE at 5-year follow-up in patients with LVEF > 50%. Noticeably, late MVO extent > 0.385 g provided relevant prognostic insights leading to improved long-term risk stratification.<br />Key Points: • Tissue markers provided by cardiac magnetic resonance aid in prognostic stratification after myocardial infarction • The occurrence of late microvascular obstruction after acute myocardial infarction increases risk of major adverse events at 5-year follow-up. • The greater microvascular obstruction extent on late gadolinium enhanced images is related to an increased risk of adverse events in patients with myocardial infarction and preserved left ventricular function.
- Subjects :
- Coronary Stenosis epidemiology
Coronary Stenosis physiopathology
Coronary Vessels diagnostic imaging
Coronary Vessels physiopathology
Disease Progression
Female
Follow-Up Studies
Humans
Incidence
Italy epidemiology
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Percutaneous Coronary Intervention adverse effects
Prognosis
ST Elevation Myocardial Infarction diagnosis
ST Elevation Myocardial Infarction physiopathology
Survival Rate trends
Time Factors
Coronary Circulation physiology
Coronary Stenosis diagnosis
Microcirculation physiology
Postoperative Complications
ST Elevation Myocardial Infarction surgery
Stroke Volume physiology
Ventricular Function, Left physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1084
- Volume :
- 29
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- European radiology
- Publication Type :
- Academic Journal
- Accession number :
- 30552479
- Full Text :
- https://doi.org/10.1007/s00330-018-5895-z