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

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 th...

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Published in:European heart journal Vol. 38; no. 47; p. 3502
Main Authors: de Waha, Suzanne, Patel, Manesh R, Granger, Christopher B, Ohman, E Magnus, Maehara, Akiko, Eitel, Ingo, Ben-Yehuda, Ori, Jenkins, Paul, Thiele, Holger, Stone, Gregg W
Format: Journal Article
Language:English
Published: England 14.12.2017
Subjects:
Aged
Coronary Circulation - physiology
Coronary Occlusion - mortality
Coronary Occlusion - surgery
Female
Heart Failure - mortality
Heart Failure - surgery
Hospitalization - statistics & numerical data
Humans
Kaplan-Meier Estimate
Magnetic Resonance Angiography
Male
Microcirculation - physiology
Middle Aged
Myocardial Reperfusion - methods
Myocardial Reperfusion - mortality
Percutaneous Coronary Intervention
Randomized Controlled Trials as Topic
Recurrence
ST Elevation Myocardial Infarction - mortality
ST Elevation Myocardial Infarction - surgery
Microvascular obstruction
Primary percutaneous coronary intervention
No-reflow phenomenon
Prognosis
ST-segment elevation myocardial infarction
ISSN:1522-9645, 1522-9645
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Summary: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.
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ISSN:1522-9645
1522-9645
DOI:10.1093/eurheartj/ehx414