In patients with reperfused acute myocardial infarction, infarct size (β -0.452, p<0.001), but not the presence of microvascular obstruction or intramyocardial hemorrhage, was the sole independent predictor of left ventricular remodeling.
Observational (n=90)
Blinded image analysis
No
Does the presence of microvascular obstruction and intramyocardial haemorrhage predict adverse left ventricular remodelling in patients with a first acute myocardial infarction undergoing primary PCI?
In patients with reperfused acute myocardial infarction, microvascular obstruction and intramyocardial haemorrhage are strongly related to infarct size, but only infarct size is an independent predictor of adverse left ventricular remodelling.
Effect estimate: β -0.452 (for infarct size)
p-value: p=<0.001
OBJECTIVES: To investigate the clinical implications of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) in acute myocardial infarction (AMI). METHODS: Ninety patients with a first AMI undergoing primary percutaneous coronary intervention (PCI) were studied. T2-weighted, cine and late gadolinium-enhanced cardiovascular magnetic resonance imaging was performed at 5 ± 2 and 103 ± 11 days. Patients were categorised into three groups based on the presence or absence of MVO and IMH. RESULTS: MVO was observed in 54% and IMH in 43% of patients, and correlated significantly (r = 0.8, p < 0.001). Pre-PCI thrombolysis in myocardial infarction 3 flow was only observed in MVO(-)/IMH(-) patients. Infarct size and impairment of systolic function were largest in MVO(+)/IMH(+) patients (n = 39, 23 ± 9% and 47 ± 7%), smallest in MVO(-)/IMH(-) patients (n = 41, 8 ± 8% and 55 ± 8%) and intermediate in MVO(+)/IMH(-) patients (n = 10, 16 ± 7% and 51 ± 6%, p < 0.001). LVEF increased in all three subgroups at follow-up, but remained intermediate in MVO(+)/IMH(-) and was lowest in MVO(+)/IMH(+) patients. Using random intercept model analysis, only infarct size was an independent predictor for adverse LV remodelling. CONCLUSIONS: Intramyocardial haemorrhage and microvascular obstruction are strongly related. Pre-PCI TIMI 3 flow is less frequently observed in patients with MVO and IMH. Only infarct size was an independent predictor of LV remodelling.
Bekkers et al. (Fri,) conducted a observational in Acute myocardial infarction (n=90). Presence of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) vs. Absence of MVO and IMH was evaluated on Independent predictors of left ventricular ejection fraction (LVEF) remodeling (β -0.452 (for infarct size), p=<0.001). In patients with reperfused acute myocardial infarction, infarct size (β -0.452, p<0.001), but not the presence of microvascular obstruction or intramyocardial hemorrhage, was the sole independent predictor of left ventricular remodeling.