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Major prognostic impact of persistent microvascular obstruction as assessed by contrast-enhanced cardiac magnetic resonance in reperfused acute myocardial infarction

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Abstract

The aim of this study was to compare the prognostic significance of microvascular obstruction (MO) and persistent microvascular obstruction (PMO) as assessed by cardiac magnetic resonance (CMR) in patients with acute myocardial infarction (AMI). CMR was performed in 184 patients within the week following successfully reperfused first AMI. First-pass images were performed to evaluate extent of MO and late gadolinium-enhanced images to assess PMO and infarct size (IS). Major adverse cardiac events (MACE) were collected at 1-year follow-up. MO and PMO were found in 127 (69%) and 87 (47%) patients, respectively. By using univariate logistic regression analysis, high Global Registry of Acute Coronary Events (GRACE) risk score (odds ratio [OR] 95% confidence interval [CI]: 3.6 [1.8–7.4], p < 0.001), IS greater than 10% (OR [95% CI]: 2.7 [1.1–6.9], p = 0.036), left ventricular ejection fraction less than 40% (OR [95% CI]: 2.4 [1.1–5.2], p = 0.027), presence of MO (OR [95% CI]: 3.1 [1.3–7.3], p = 0.004) and presence of PMO (OR [95% CI]:10 [4.1–23.9], p < 0.001) were shown to be significantly associated with the outcome. By using multivariate analysis, presence of MO (OR [95% CI]: 2.5 [1.0–6.2], p = 0.045) or of PMO (OR [95% CI]: 8.7 [3.6–21.1], p < 0.001), associated with GRACE score, were predictors of MACE. Presence of microvascular obstruction and persistent microvascular obstruction is very common in AMI patients even after successful reperfusion and is associated with a dramatically higher risk of subsequent cardiovascular events, beyond established prognostic markers. Moreover, our data suggest that the prognostic impact of PMO might be superior to MO.

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Acknowledgements

This work was supported by the Association de Cardiologie de Bourgogne and by grants from the University Hospital of Dijon, France. The authors are grateful for P. Bastable for his help in the preparation of the manuscript, and Dr C. Boichot for the collection of data.

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Authors and Affiliations

  1. Unité d’IRM et CNRS UMR 5158, CHU Hôpital d’Enfants, Boulevard du Maréchal de Lattre de Tassigny, 21034, Dijon, France

    Alexandre A. Cochet, Alain Lalande, Paul M. Walker, Claude Touzery, Jean-Eric Wolf & François Brunotte

  2. Département de Cardiologie, CHU Bocage, Boulevard du Maréchal de Lattre de Tassigny, 21034, Dijon, France

    Luc Lorgis, Jean-Claude Beer, Jean-Eric Wolf & Yves Cottin

  3. Institut Fédératif de Recherche 100 Santé STIC, Université de Bourgogne, Bourgogne, France

    Marianne Zeller

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  1. Alexandre A. Cochet
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  2. Luc Lorgis
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Correspondence to Alexandre A. Cochet.

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Cochet, A.A., Lorgis, L., Lalande, A. et al. Major prognostic impact of persistent microvascular obstruction as assessed by contrast-enhanced cardiac magnetic resonance in reperfused acute myocardial infarction. Eur Radiol 19, 2117–2126 (2009). https://doi.org/10.1007/s00330-009-1395-5

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  • DOI: https://doi.org/10.1007/s00330-009-1395-5

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