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Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction as visualized by magnetic resonance imaging

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Abstract

Background

Both infarct size and microvascular obstruction (MO) assessed by cardiac magnetic resonance imaging (CMR) are known to be predictors for adverse clinical outcome after ST-elevation myocardial infarction (STEMI). We hypothesized that a ratio of MO and infarct size (MO/infarct size) might be an even stronger predictor for outcome after STEMI, which has not been investigated yet.

Methods

STEMI patients reperfused by primary angioplasty (n = 438) within 12 h after symptom onset underwent contrast-enhanced CMR at a median of 3 days (interquartile range [IQR] 2;4) after the index event. MO and infarct size were measured 15 min after intravenous gadolinium injection. Follow-up was conducted after 19 months (IQR 10;27). The primary end point was defined as a composite of death, non-fatal myocardial reinfarction and congestive heart failure (major adverse cardiac events [MACE]).

Results

The extent of MO was only weakly correlated with infarct size (r = 0.21, p < 0.001). In a first multivariate analysis including extent of MO, infarct size, ejection fraction, end-systolic and end-diastolic volume, the extent of MO was independently associated with MACE (hazard ratio [HR] 1.03, 95%CI 1.02–1.05, p < 0.001). In a second multivariate analysis including MO/infarct size on top of the extent of MO, infarct size, ejection fraction, end-systolic and end-diastolic volume, MO/infarct size was identified as the strongest independent predictor for MACE (HR 2.22 [95%CI 1.60–3.08, p < 0.001]).

Conclusions

In contrast to infarct size, MO is associated with adverse clinical outcome after STEMI even after adjustment for other CMR parameters. However, MO/infarct size is a more powerful predictor for long-term outcome after STEMI than either parameter alone.

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Authors and Affiliations

  1. Department of Internal Medicine, Cardiology, University of Leipzig-Heart Center, Strümpellstr. 39, Leipzig, 04289, Germany

    Suzanne de Waha, Steffen Desch, Ingo Eitel, Georg Fuernau, Philipp Lurz, Anja Leuschner, Gerhard Schuler & Holger Thiele

  2. Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, German

    Matthias Grothoff & Matthias Gutberlet

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  1. Suzanne de Waha
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  2. Steffen Desch
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  3. Ingo Eitel
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Correspondence to Suzanne de Waha.

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de Waha, S., Desch, S., Eitel, I. et al. Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction as visualized by magnetic resonance imaging. Clin Res Cardiol 101, 487–495 (2012). https://doi.org/10.1007/s00392-012-0419-3

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  • DOI: https://doi.org/10.1007/s00392-012-0419-3

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