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Eur Heart J. 2017 Dec 14;38(47):3502-3510. doi: 10.1093/eurheartj/ehx414.

Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials.

Author information

1
University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Luebeck, Germany.
2
German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
3
Duke University Medical Centre, 2400 Pratt Street, Durham, NC 27705, USA.
4
Columbia University Medical Centre, New York Presbyterian Hospital, 630 W 168th Street, New York, NY 10032, USA.
5
Cardiovascular Research Foundation, 1700 Broadway, 8th Floor, New York, NY 10019, USA.
6
Heart Centre Leipzig, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.

Abstract

Aims:

Microvascular obstruction (MVO) is the underlying cause for the no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI). The association between MVO assessed by cardiac magnetic resonance imaging (CMR) and prognosis has not been convincingly demonstrated. We sought to determine the relationship between MVO assessed early after primary percutaneous coronary intervention (PCI) in STEMI and all-cause mortality, hospitalization for heart failure (HF), and reinfarction.

Methods and results:

We performed a pooled analysis using individual patient data from seven randomized primary PCI trials in which MVO was assessed within 7 days after reperfusion by CMR using late gadolinium enhancement imaging (n = 1688). Clinical follow-up was performed for at least 6 months after the index event. Median time to CMR after STEMI was 3 days [interquartile range (IQR) 2-4], and median duration of clinical follow-up was 365 days (IQR 188-374). Microvascular obstruction was present in 960 (56.9%) of patients, and median MVO (percent left ventricular myocardial mass) was 0.47% (IQR 0.00-2.54). A graded response was present between the extent of MVO (per 1.0% absolute increase) and subsequent mortality [Cox adjusted hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.09-1.19, P < 0.0001] and hospitalization for HF (Cox adjusted HR 1.08, 95% CI 1.05-1.12, P < 0.0001). Microvascular obstruction remained significantly associated with all-cause mortality even after further adjustment for infarct size (Cox adjusted HR 1.09, 95% CI 1.01-1.17, P = 0.03). MVO was not significantly related to subsequent reinfarction (P = 0.29).

Conclusions:

The presence and extent of MVO measured by CMR after primary PCI in STEMI are strongly associated with mortality and hospitalization for HF within 1 year.

KEYWORDS:

Microvascular obstruction; No-reflow phenomenon; Primary percutaneous coronary intervention; Prognosis; ST-segment elevation myocardial infarction

PMID:
29020248
DOI:
10.1093/eurheartj/ehx414
[Indexed for MEDLINE]

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