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
Top Cited Papers
Open Access
- 28 July 2017
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 38 (47), 3502-3510
- https://doi.org/10.1093/eurheartj/ehx414
Abstract
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. 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). 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
Funding Information
- Cardiovascular Research Foundation
This publication has 35 references indexed in Scilit:
- Coronary microvascular obstruction in acute myocardial infarctionEuropean Heart Journal, 2015
- CMR Assessment of Microvascular Obstruction in STEMIJournal of the American College of Cardiology, 2014
- 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial InfarctionJournal of the American College of Cardiology, 2012
- ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevationEuropean Heart Journal, 2012
- 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 markersEuropean Heart Journal, 2010
- Myocardial No-Reflow in HumansJournal of the American College of Cardiology, 2009
- Microvascular Obstruction and the No-Reflow Phenomenon After Percutaneous Coronary InterventionCirculation, 2008
- Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic significance as assessed by magnetic resonance imagingEuropean Heart Journal, 2005
- Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusionJournal of the American College of Cardiology, 1998
- Prognostic Significance of Microvascular Obstruction by Magnetic Resonance Imaging in Patients With Acute Myocardial InfarctionCirculation, 1998