Abstract
Microvascular obstruction (MO) and coronary flow have been independently described to have a high prognostic impact after acute myocardial infarction (AMI). Their interdependence has not been precisely elucidated, so far. Aim of this study was to investigate the impact of coronary flow on the occurrence of MO in patients with AMI. 336 patients with revascularized AMI were examined by cardiac magnetic resonance imaging. Patients were categorised into two groups based on the presence of MO. Procedural characteristics and marker of infarct size were analyzed. MO was present in 110 (33 %) and absent in 226 (67 %) patients. Both groups differed significantly regarding pre- and post-interventional thrombolysis in myocardial infarction (TIMI) flow. After multivariable regression analysis pre-interventional TIMI-flow 0, proximal culprit lesion, post-interventional TIMI-flow <III and creatine-kinase–myocardial band (CK-MB) remained strong independent predictors for MO. Odds ratios for pre-interventional TIMI-flow 0 were 2.31 (95 % CI 1.04–5.11, P = 0.034); for proximal culprit lesion 11.94 (95 % CI 5.70–25.01, P < 0.001); for post-interventional TIMI-flow III 0.28 (95 % CI 0.10–0.74, P = 0.010) and for CK-MB 1.50 (95 % CI 1.24–1.82, P < 0.001). Pre-interventional proximal coronary artery occlusion (TIMI 0) and insufficient post-interventional coronary reperfusion (TIMI-flow <III) have a high impact on the occurrence of MO in AMI.
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Reimer KA, Lowe JE, Rasmussen MM et al (1977) The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation 56:786–794. doi:10.1161/01.CIR.56.5.786
Reffelmann T, Kloner RA (2006) The no-reflow phenomenon: a basic mechanism of myocardial ischemia and reperfusion. Basic Res Cardiol 101:359–372. doi:10.1007/s00395-006-0615-2
Ghugre NR, Ramanan V, Pop M et al (2011) Quantitative tracking of edema, hemorrhage, and microvascular obstruction in subacute myocardial infarction in a porcine model by MRI. Magn Reson Med 66:1129–1141. doi:10.1002/mrm.22855
de Waha S, Desch S, Eitel I et al (2010) Impact of early vs. late microvascular obstruction assessed by magnetic resonance imaging on long-term outcome after ST-elevation myocardial infarction: a comparison with traditional prognostic markers. Eur Heart J 31:2660–2668. doi:10.1093/eurheartj/ehq247
Wu KC, Zerhouni EA, Judd RM et al (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 97:765–772. doi:10.1161/01.CIR.97.8.765
Nijveldt R, Beek AM, Hirsch A et al (2008) Functional recovery after acute myocardial infarction: comparison between angiography, electrocardiography, and cardiovascular magnetic resonance measures of microvascular injury. J Am Coll Cardiol 52:181–189. doi:10.1016/j.jacc.2008.04.006
Mather AN, Lockie T, Nagel E et al (2009) Appearance of microvascular obstruction on high resolution first-pass perfusion, early and late gadolinium enhancement CMR in patients with acute myocardial infarction. J Cardiovasc Magn Reson 11:33. doi:10.1186/1532-429X-11-33
Brener SJ, Dambrink J-H, Maehara A et al (2014) Benefits of optimising coronary flow before stenting in primary percutaneous coronary intervention for ST-elevation myocardial infarction: insights from INFUSE-AMI. EuroIntervention 9(10):1195–1201
Ndrepepa G, Mehilli J, Schulz S et al (2008) Prognostic significance of epicardial blood flow before and after percutaneous coronary intervention in patients with acute coronary syndromes. J Am Coll Cardiol 52:512–517. doi:10.1016/j.jacc.2008.05.009
Ndrepepa G, Alger P, Fusaro M et al (2011) Impact of perfusion restoration at epicardial and tissue levels on markers of myocardial necrosis and clinical outcome of patients with acute myocardial infarction. EuroIntervention 7:128–135. doi:10.4244/EIJV7I1A21
Rakowski T, Dudek D, Dziewierz A et al (2013) Impact of infarct-related artery patency before primary PCI on outcome in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. EuroIntervention 8:1307–1314. doi:10.4244/EIJV8I11A199
Mehta RH, Ou F-S, Peterson ED et al (2009) Clinical significance of post-procedural TIMI flow in patients with cardiogenic shock undergoing primary percutaneous coronary intervention. J Am Coll Cardiol Cardiovasc Interv 2:56–64. doi:10.1016/j.jcin.2008.10.006
Muller HS, Greenberg MA, Dyer JG (1985) The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI study group. N Engl J Med 312:932–936. doi:10.1056/NEJM198504043121435
Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40
Zeymer U, Huber K, Fu Y et al (2012) Impact of TIMI 3 patency before primary percutaneous coronary intervention for ST-elevation myocardial infarction on clinical outcome: results from the ASSENT-4 PCI study. Eur Heart J 1:136–142. doi:10.1177/2048872612447069
Brener SJ, Mehran R, Brodie BR et al (2011) Predictors and implications of coronary infarct artery patency at initial angiography in patients with acute myocardial infarction (from the CADILLAC and HORIZONS-AMI trials). Am J Cardiol 108:918–923. doi:10.1016/j.amjcard.2011.05.022
De Luca G, Ernst N, Zijlstra F et al (2004) Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 43:1363–1367. doi:10.1016/j.jacc.2003.11.042
Stone GW, Cox D, Garcia E et al (2001) Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation 104:636–641
Guerra E, Hadamitzky M, Ndrepepa G et al (2014) Microvascular obstruction in patients with non-ST-elevation myocardial infarction: a contrast-enhanced cardiac magnetic resonance study. Int J Cardiovasc Imaging 30:1087–1095. doi:10.1007/s10554-014-0430-z
Schaaf MJ, Mewton N, Rioufol G et al (2016) Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients. J Cardiol 67(3):248–253. doi:10.1016/j.jjcc.2015.05.008
Khan JN, Razvi N, Nazir SA et al (2014) Prevalence and extent of infarct and microvascular obstruction following different reperfusion therapies in ST-elevation myocardial infarction. J Cardiovasc Magn Reson 16:38. doi:10.1186/1532-429X-16-38
Svilaas T, Vlaar PJ, van der Horst IC et al (2008) Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med 358:557–567. doi:10.1056/NEJMoa0706416
Vlaar PJ, Svilaas T, van der Horst IC et al (2008) Cardiac death and reinfarction after 1 year in the thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study (TAPAS): a 1-year follow-up study. Lancet 371:1915–1920. doi:10.1016/S0140-6736(08)60833-8
Javaid A, Siddiqi NH, Steinberg DH et al (2008) Adjunct thrombus aspiration reduces mortality in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction with high-risk angiographic characteristics. Am J Cardiol 101:452–456. doi:10.1016/j.amjcard.2007.09.091
Thiele H, de Waha S, Zeymer U et al (2014) Effect of aspiration thrombectomy on microvascular obstruction in NSTEMI patients: the TATORT-NSTEMI trial. J Am Coll Cardiol 64:1117–1124. doi:10.1016/j.jacc.2014.05.064
Ota S, Tanimoto T, Orii M et al (2015) Association between hyperglycemia at admission and microvascular obstruction in patients with ST-segment elevation myocardial infarction. J Cardiol 65(4):272–277. doi:10.1016/j.jjcc.2014.10.013
Wong DTL, Leung MCH, Richardson JD et al (2012) Cardiac magnetic resonance derived late microvascular obstruction assessment post ST-segment elevation myocardial infarction is the best predictor of left ventricular function: a comparison of angiographic and cardiac magnetic resonance derived measurements. Int J Cardiovasc Imaging 28:1971–1981. doi:10.1007/s10554-012-0021-9
Hamirani YS, Wong A, Kramer CM et al (2014) Effect of microvascular obstruction and intramyocardial hemorrhage by CMR on LV remodeling and outcomes after myocardial infarction: a systematic review and meta-analysis. J Am Coll Cardiol Cardiovasc Imaging 7:940–952. doi:10.1016/j.jcmg.2014.06.012
Rochitte CE, Lima JA, Bluemke DA et al (1998) Magnitude and time course of microvascular obstruction and tissue injury after acute myocardial infarction. Circulation 98:1006–1014
Wu KC, Kim RJ, Bluemke DA et al (1998) Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion. J Am Coll Cardiol 32:1756–1764. doi:10.1016/S0735-1097(98)00429-X
Acknowledgments
We thank the staff of the cardiovascular magnetic resonance imaging department of the HELIOS Universitätsklinikum Wuppertal.
Funding
This study was supported by HELIOS Kliniken GmbH, [Grant ID 003138].
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Abanador-Kamper, N., Kamper, L., Karamani, V. et al. Proximal culprit lesion and coronary artery occlusion independently predict the risk of microvascular obstruction in acute myocardial infarction. Int J Cardiovasc Imaging 32, 1235–1242 (2016). https://doi.org/10.1007/s10554-016-0897-x
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DOI: https://doi.org/10.1007/s10554-016-0897-x