Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction
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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).
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.
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).
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.
• 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.
KeywordsCardiac magnetic resonance Acute myocardial infarction Left ventricular ejection fraction Major adverse cardiovascular events Microvascular obstruction
Area at risk
Angiotensin converting enzyme
Acute myocardial infarction
Angiotensin receptor blocker
Area under the curve
Coronary artery bypass graft
Cardiac magnetic resonance
Heart failure with preserved ejection fraction
Late gadolinium enhancement
Left ventricular ejection fraction
Left ventricular systolic dysfunction
Major adverse cardiovascular events
Non ST segment elevation myocardial infarction
Percutaneous coronary intervention
ST segment elevation myocardial infarction
Short tau inversion recovery
Thrombolysis in myocardial infarction
Turbo spin echo
Wall motion score index
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Marco Francone, MD PhD, EBCR.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was obtained from all patients in this study.
Institutional Review Board approval was obtained.
• performed at one institution
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