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February 21, 2022Frontiers in Cardiovascular MedicineOpen Access

Microvascular occlusion on contrast-enhanced cine linked to ~210% higher MACE risk in STEMI after PCI.

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Why the study?

CMR enables one-step evaluation of myocardial function and pathology after STEMI, but the predictive value of combining fast MVO identification from CE-SSFP with myocardial strain for MACE remained to be evaluated.

Does fast MVO identification from CE-SSFP combined with myocardial strain predict MACE in patients with STEMI after primary PCI?

Population

237 STEMI patients who underwent pPCI and completed CMR within 1 week

Comparison

Fast MVO identification from CE-SSFP combined with myocardial strain

Design

Cohort study

Follow-up

13 months [IQR: 11–24]

Key result

Microvascular occlusion identified from contrast-enhanced cine was independently associated with major adverse cardiovascular events (HR 3.10) in patients with STEMI after primary PCI.

Authors

MZMin ZhangYLYuan LüZLZhi Li

Discussion

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Member takes

Overview

MVO on contrast cine may aid post-STEMI risk stratification; leaves open prospective validation of combined strain assessment before clinical adoption.

Study Design

Type

Cohort (n=237)

Multicenter

No

Structured PICO

Does fast MVO identification from CE-SSFP combined with myocardial strain predict MACE in patients with STEMI after primary PCI?

P
Population
215 adults with first ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) within 24 hours of ischemic symptoms and Killip class <3, median age 58, 19% female, based in China.
I
Intervention
Fast microvascular occlusion (MVO) identification from contrast-enhanced steady-state free precession (CE-SSFP) combined with myocardial strain (global longitudinal strain) via cardiac magnetic resonance imaging (CMR) within 1 week of pPCI.
O
Outcome
Major cardiovascular adverse events (MACEs), defined as a composite of all-cause death, myocardial reinfarction, and new congestive heart failure (HF) after discharge at median 13 months follow-up.composite

Main Result

Effect estimate: HR 3.10 (95% CI 1.14-8.99)

p-value: p=0.028

Fast MVO identification from contrast-enhanced cine combined with global longitudinal strain provides a reliable and quick prognostic tool for predicting MACE in STEMI patients after primary PCI.

Limitations

  • Only stable patients (Killip <3) with first STEMI treated with pPCI were included, limiting extrapolation to all STEMI patients.
  • Did not perform measurements for emerging CMR parameters such as native T1 mapping, extracellular volume, and T2* mapping.
  • Potential inconsistencies between commercially available strain assessment software.
  • Emerging CMR parameters (native T1 mapping, extracellular volume, and T2* mapping) were unavailable and not measured.
  • Inconsistencies between commercially available strain assessment software should be considered.

Cite This Study

Zhang et al. (2022) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=237). Microvascular occlusion (MVO) identification from contrast-enhanced cine (CE-SSFP) was evaluated on Major cardiovascular adverse events (MACE) (HR 3.10, 95% CI 1.14-8.99, p=0.028). Microvascular occlusion identified from contrast-enhanced cine was independently associated with major adverse cardiovascular events (HR 3.10) in patients with STEMI after primary PCI.

synapsesocial.com/papers/6a166e12994c1ef0e34c5bbfhttps://doi.org/10.3389/fcvm.2021.804020
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Diagnostic performance of cardiac magnetic resonance segmental myocardial strain for detecting microvascular obstruction and late gadolinium enhancement in patients presenting after a ST-elevation myocardial infarction2022 · 19 citations
  2. 2Microvascular perfusion patterns identified by contrast-enhanced CMR: prognostic implications in STEMI2025
  3. 3Cardiac magnetic resonance imaging improves prognostic stratification of patients with ST-elevation myocardial infarction and preserved ejection fraction2021 · 12 citations
  4. 4The value of microvascular obstruction according to contrast-enhanced cardiac magnetic resonance imaging in assessing the prognosis of patients with acute ST-segment elevation myocardial infarction2024
  5. 5A contrast-enhanced CMR-based risk score integrating microvascular obstruction and intramyocardial hemorrhage extent for prognostic evaluation2026