Cardiac sympathetic nerve activity in the non-culprit lesion predicts poor prognosis in patients with STEMI

Purpose Although cardiac sympathetic nerve activity (CSNA) has been reported to be associated with poor prognosis in patients with acute myocardial infarction, there is limited information on the prognostic value of regional CSNA compared with established risk scores and global CSNA in patients with ST-elevation myocardial infarction (STEMI). Therefore, we aimed to determine whether regional CSNA provides incremental prognostic value in patients with STEMI. Methods We prospectively studied 122 patients with STEMI. CSNA was assessed with washout rate (WR) from planar images (global WR) and the average WR in the culprit and non-culprit lesion in the SPECT images of cardiac 123 I-MIBG imaging. Results During a follow-up period of 4.2 ± 2.5 years, 34 patients experienced primary endpoint, major adverse cardiac event (MACE). Abnormal global WR on planar image and the increased WR in the non-culprit lesion, but not in the culprit lesion, were significantly independently associated with MACE after mutual adjustment and after controlling for clinical parameters, GRACE or TIMI risk score. Patients with both global abnormal WR and the increased WR in the non-culprit lesion had a significantly higher risk for MACE than those with either ( *p* = 0.025) global abnormal WR or the increased WR in the non-culprit lesion and those with none of them ( *p* < 0.001). Conclusion The enhanced cardiac sympathetic nerve activity in the non-culprit lesion on SPECT imaging provides additional prognostic value to global WR on planar images in patients with ST-elevation myocardial infarction. Clinical trial registration This study has been registered with UMIN (UMIN ID: UMIN000020528, URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000023700)