Prognostic Value of Microvascular Obstruction and Infarct Size, as Measured by CMR in STEMI Patients

• Published in: JACC. Cardiovascular imaging Vol. 7; no. 9; pp. 930 - 939
• Main Authors: van Kranenburg, Matthijs, Magro, Michael, Thiele, Holger, de Waha, Suzanne, Eitel, Ingo, Cochet, Alexandre, Cottin, Yves, Atar, Dan, Buser, Peter, Wu, Edwin, Lee, Daniel, Bodi, Vicente, Klug, Gert, Metzler, Bernhard, Delewi, Ronak, Bernhardt, Peter, Rottbauer, Wolfgang, Boersma, Eric, Zijlstra, Felix, van Geuns, Robert-Jan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2014; Elsevier/American College of Cardiology
• Subjects: Aged; Bioengineering; cardiac magnetic resonance; Cardiovascular; Coronary Circulation; Female; Heart Failure - mortality; Heart Failure - physiopathology; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Humans; infarct size; Life Sciences; Magnetic Resonance Imaging; Male; Microcirculation; microvascular obstruction; Middle Aged; myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardium - pathology; No-Reflow Phenomenon - diagnosis; No-Reflow Phenomenon - pathology; No-Reflow Phenomenon - physiopathology; Nuclear medicine; Percutaneous Coronary Intervention - adverse effects; Predictive Value of Tests; prognosis; Recurrence; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; infarct size; MO; pPCI; MACE; myocardial infarction; STEMI; IS; LV; CE-CMR; cardiac magnetic resonance; prognosis; microvascular obstruction; major adverse cardiac events; contrast-enhanced cardiac magnetic resonance; primary percutaneous coronary intervention; left ventricular; ST-segment elevation myocardial infarction
• ISSN: 1936-878X; 1876-7591; 1876-7591
• DOI: 10.1016/j.jcmg.2014.05.010

The aim of this study was to evaluate the value of microvascular obstruction (MO) and infarct size as a percentage of left ventricular mass (IS%LV), as measured by contrast-enhanced cardiac magnetic resonance, in predicting major cardiovascular adverse events (MACE) at 2 years in patients with ST-segment elevation myocardial infarction reperfused by primary percutaneous coronary intervention. Individual data from 1,025 patients were entered into the pooled analysis. MO was associated with the occurrence of MACE, defined as a composite of cardiac death, congestive heart failure, and myocardial re-infarction (adjusted hazard ratio: 3.74; 95% confidence interval: 2.21 to 6.34). IS%LV ≥25% was not associated with MACE (adjusted hazard ratio: 0.90; 95% confidence interval: 0.59 to 1.37). The authors conclude that MO is an independent predictor of MACE and cardiac death, whereas IS%LV is not independently associated with MACE.