What is the clinical evidence from this study?

Study design: Cohort. Population: acute ST-elevation myocardial infarction (n=129). Intervention: early microvascular obstruction (MVO) assessment by CMR vs. patients without early MVO. Primary outcome: composite of death, myocardial re-infarction, stroke, repeat revascularization, recurrence of ischemic symptoms, atrial fibrillation, congestive heart failure and hospitalization (HR 2.20, 95% CI 1.11-4.36, p=0.024).

What does this research mean for the field?

Early microvascular obstruction (MVO), assessed by cardiovascular magnetic resonance (CMR), is associated with a 66.2% occurrence of adverse outcomes after acute myocardial infarction (AMI), indicating a significantly higher risk compared to 42.4% in patients without MVO. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 1, 2012Journal of Cardiovascular Magnetic ResonanceOpen Access

Prognostic value at 5 years of microvascular obstruction after acute myocardial infarction assessed by cardiovascular magnetic resonance

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Key result

Early microvascular obstruction, assessed by CMR, was associated with a 66.2% occurrence of the primary composite endpoint compared to 42.4% in patients without MVO, with HR 2.20 indicating a significantly higher risk of adverse outcomes.

Why the study?

Does the presence of early microvascular obstruction assessed by CMR predict adverse clinical outcomes in patients reperfused by pPCI for STEMI?

Population

Patients reperfused by primary percutaneous coronary intervention for first ST-elevation myocardial…

Comparison

Presence of early microvascular obstruction… vs Absence of early microvascular obstruction (eMVO-)

Design

Cohort, Endpoints defined by a consensus of investigators blinded to the CMR…

Follow-up

median 52 months

Authors

GKGert KlugUniversity of Teacher Education Styria AMAgnes MayrCardiac Imaging SSS. SchenkInnsbruck Medical University

Discussion

Member takes

Implication

May refine post-STEMI risk stratification; extends observational data but leaves open prospective validation.

Key Points

This research aims to determine the prognostic value of early microvascular obstruction after acute myocardial infarction using cardiovascular magnetic resonance imaging.
Assessed microvascular obstruction using first-pass cardiovascular magnetic resonance imaging
Monitored morbidity over a long-term period of 5 years
Microvascular obstruction is identified as an independent prognosticator for long-term morbidity after acute myocardial infarction.

Study Design

Type

Cohort (n=129)

Multicenter

Structured PICO

Does the presence of early microvascular obstruction assessed by CMR predict adverse clinical outcomes in patients reperfused by pPCI for STEMI?

Population

Patients reperfused by primary percutaneous coronary intervention (pPCI) for first ST-elevation myocardial infarction (STEMI) with Killip class <2 and no pre-existing heart failure.

Intervention

Presence of early microvascular obstruction (eMVO+) assessed by first-pass cardiovascular magnetic resonance (CMR)

Comparator

Absence of early microvascular obstruction (eMVO-)

Outcome

Composite of death, myocardial re-infarction, stroke, repeat revascularization, recurrence of ischemic symptoms, atrial fibrillation, congestive heart failure and hospitalization of any causecomposite

Main Result

Effect estimate: HR 2.20 (95% CI 1.11-4.36)

Absolute Event Rate: 66.2% vs 42.4%

p-value: p=0.024

Early microvascular obstruction assessed by first-pass CMR is a strong independent predictor of long-term cardiovascular morbidity at 5 years in patients after STEMI.

Limitations

Small sample size limited the power of the study to detect differences in some outcomes.
The composite endpoint may mask important individual outcomes.
Relatively small sample size, which necessitates the use of a combined primary endpoint
Use of 3 short-axis slices might underestimate the presence of MVO compared to the six to eight slices acquired on LGE images

Cite This Study

Klug et al. (2012) conducted a cohort in acute ST-elevation myocardial infarction (n=129). early microvascular obstruction (MVO) assessment by CMR vs. patients without early MVO was evaluated on composite of death, myocardial re-infarction, stroke, repeat revascularization, recurrence of ischemic symptoms, atrial fibrillation, congestive heart failure and hospitalization (HR 2.20, 95% CI 1.11-4.36, p=0.024). Early microvascular obstruction, assessed by CMR, was associated with a 66.2% occurrence of the primary composite endpoint compared to 42.4% in patients without MVO, with HR 2.20 indicating a significantly higher risk of adverse outcomes.

synapsesocial.com/papers/6978067bb4f402aaa34cc65c https://doi.org/10.1186/1532-429x-14-46

Topics

Cardiac MRI Heart failure HFrEF treatment

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Prognostic value at 5 years of microvascular obstruction after acute myocardial infarction assessed by cardiovascular magnetic resonance

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Prognostic value at 5 years of microvascular obstruction after acute myocardial infarction assessed by cardiovascular magnetic resonance

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider