Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome After Primary Coronary Angioplasty for Acute Myocardial Infarction

Abstract

Background-We hypothesized that preserved microvascular integrity in the area at risk would favorably influence left ventricular (LV) remodeling and long-term outcome after acute myocardial infarction. Methods and Results-Before and after successful primary angioplasty (percutaneous transluminal coronary angioplasty[PTCA]), 124 patients with acute myocardial infarction underwent intracoronary myocardial contrast echo (MCE). An MCE score index (MCESI) was derived by averaging the single-segment score (0ϭnot visible, 1ϭpatchy, 2ϭhomo-geneous contrast effect) within the area at risk. An MCESI Ն1 was considered adequate reperfusion. Mean follow-up was 46Ϯ32 months. After PTCA, 100 patients showed adequate reperfusion (no microvascular dysfunction, NoMD), whereas 24 did not (MD

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

“…The use of gated SPECT to assess left ventricular function from perfusion data is the innovative methodological contribution of this study. Although area at risk and final infarct size are considered reliable surrogate end-points for studies comparing different treatment strategies in acute myocardial infarction [22], the prognostic implications of left ventricular ejection fraction and left ventricular volumes are well known [23][24][25]. Gated SPECT could be particularly advantageous for this kind of study, given that it allows reproducible assessment of both perfusion and functional changes [2-5, 16, 17, 26].…”

Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function

“…17 Dilation portends a poor long-term outcome. Prior evidence for an association between persistent IRA occlusion and late-phase LV remodeling, 18 characterized by increased contractile segment length and change in shape toward the spherical, 19 is more robust than the evidence for the association of IRA status and global LV systolic function.…”

Pathophysiological aspects and management workflow of coronary microvascular obstruction in ST-segment elevation myocardial infarction

“…39 MCE detected CMVO was associated with an enhancement of the risk of adverse remodelling at 6 months 33 and of cardiac death after 46 months. 40 CMR detected CMVO increased the risk of adverse remodelling at 6 months 41 and of death. 42 The lack of STR Coronary microvascular obstruction raised the risk of total mortality after 30 days but failed to predict adverse left ventricular remodelling.…”

“…21,[36][37][38][39][40][41][42][43] In particular, TIMI flow ≤2 is associated with an increased risk of adverse remodelling at 6 months 36 and of 5-year mortality. 37 MBG 0-1 raised the risk of adverse remodelling at 6 months 38 and of total mortality after 16 months of follow-up.…”