Key result
Baseline myocardial infarction size, rather than anterior location, was an independent predictor of adverse left ventricular remodeling (OR 1.061, p<0.001) at 4-month follow-up.
Why the study?
Does anterior MI location independently predict adverse LV remodeling compared to non-anterior MI in reperfused STEMI patients?
Cohort (n=260)
Yes
Does anterior MI location independently predict adverse LV remodeling compared to non-anterior MI in reperfused STEMI patients?
Effect estimate: OR 1.061
p-value: p=<0.001
In reperfused STEMI patients, baseline MI size, rather than infarct location, is the primary independent predictor of adverse LV remodeling and reduced ejection fraction.
MI size, not anterior location, should inform remodeling risk in reperfused STEMI; leaves open whether size-targeted strategies alter outcomes.
Background Patients with anterior MI experience worse LV remodeling and dysfunction than non-anterior MI patients. It remains unclear whether this difference is due to larger MI size or whether infarct location plays a role beyond MI size. Study aim To assess the relationship between myocardial infarction (MI) location and size and their reciprocal influences on post-infarction left ventricular (LV) remodeling. Methods A cohort of 260 reperfused ST-segment elevation MI patients was studied with cardiovascular magnetic resonance (CMR) at 1-week (baseline) and 4-month (followup). Area at risk (AAR) and MI size were quantified by T2-weighted and late gadolinium enhancement imaging, respectively. Adverse LV remodeling was defined as increase in LV end-systolic volume ≥15% at follow-up. Results One-hundred 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 remodeling (p=0.017) and lower LV ejection-fraction 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 remodeling (OR=1.061, p<0.001) and ejection-fraction at follow-up (Beta-coefficient=-0.255, p<0.001).
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Masci et al. (2011) conducted a cohort in ST-segment elevation myocardial infarction (n=260). Anterior MI vs. Non-anterior MI was evaluated on Adverse LV remodeling (increase in LV end-systolic volume ≥15% at follow-up) (OR 1.061, p=<0.001). Baseline myocardial infarction size, rather than anterior location, was an independent predictor of adverse left ventricular remodeling (OR 1.061, p<0.001) at 4-month follow-up.
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