Key result
Baseline myocardial infarction size, rather than anterior location, independently predicted adverse left ventricular remodelling at 4 months (OR 1.061, P<0.001).
Why the study?
The relationship between myocardial infarction location and size and their reciprocal influences on post-infarction left ventricular remodelling was not fully understood.
Does anterior MI location independently predict adverse LV remodelling compared to non-anterior MI in reperfused STEMI patients?
Cohort (n=260)
Does anterior MI location independently predict adverse LV remodelling compared to non-anterior MI in reperfused STEMI patients?
Anterior MI is associated with worse post-infarction LV remodelling than non-anterior MI, but this is driven entirely by larger infarct size rather than the location itself.
Answers are grounded in this paper and cite their sources.
MI size, not location, should guide remodelling risk assessment after STEMI; leaves open whether size reduction alone prevents adverse outcomes.
AIMS: To assess the intricate relationship between myocardial infarction (MI) location and size and their reciprocal influences on post-infarction left ventricular (LV) remodelling. METHODS AND RESULTS: A cohort of 260 reperfused ST-segment elevation MI patients was prospectively studied with cardiovascular magnetic resonance at 1 week (baseline) and 4 months (follow-up). Area at risk (AAR) and MI size were quantified by T2-weighted and late-gadolinium enhancement imaging, respectively. Adverse LV remodelling was defined as an increase in LV end-systolic volume ≥15% at follow-up. One hundred and twenty-seven (49%) patients had anterior MI and 133 (51%) patients had non-anterior MI. Although the degree of myocardial salvage was similar between groups (P = 0.74), anterior MI patients had larger AAR and MI size than non-anterior MI patients yielding worse regional and global LV function at baseline and follow-up. At univariable analysis, anterior MI was associated with increased risk of adverse LV remodelling (P = 0.017) and lower LV ejection fraction (EF) at follow-up (P = 0.001), but not when accounted for baseline MI size. Accordingly, at multivariable analysis, baseline MI size but not its location was an independent predictor of adverse LV remodelling (odds ratio = 1.061, P < 0.001) and EF at follow-up (β-coefficient = -0.255, P < 0.001). CONCLUSION: Anterior MI patients experience more pronounced post-infarction LV remodelling and dysfunction than non-anterior MI patients due to a greater magnitude of irreversible ischaemic LV damage without any independent contribution of MI location.
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Masci et al. (2011) conducted a cohort in ST-segment elevation myocardial infarction (n=260). Anterior myocardial infarction vs. Non-anterior myocardial infarction was evaluated on Adverse left ventricular remodelling (increase in LV end-systolic volume ≥15% at follow-up) (OR 1.061, p=<0.001). Baseline myocardial infarction size, rather than anterior location, independently predicted adverse left ventricular remodelling at 4 months (OR 1.061, P<0.001).
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