Major prognostic impact of persistent microvascular obstruction as assessed by contrast-enhanced cardiac magnetic resonance in reperfused acute myocardial infarction

Abstract

The aim of this study was to compare the prognostic significance of microvascular obstruction (MO) and persistent microvascular obstruction (PMO) as assessed by cardiac magnetic resonance (CMR) in patients with acute myocardial infarction (AMI). CMR was performed in 184 patients within the week following successfully reperfused first AMI. First-pass images were performed to evaluate extent of MO and late gadolinium-enhanced images to assess PMO and infarct size (IS). Major adverse cardiac events (MACE) were collected at 1-year follow-up. MO and PMO were found in 127 (69%) and 87 (47%) patients, respectively. By using univariate logistic regression analysis, high Global Registry of Acute Coronary Events (GRACE) risk score (odds ratio [OR] 95% confidence interval [CI]: 3.6 [1.8-7.4], p < 0.001), IS greater than 10% (OR [95% CI]: 2.7 [1.1-6.9], p = 0.036), left ventricular ejection fraction less than 40% (OR [95% CI]: 2.4 [1.1-5.2], p = 0.027), presence of MO (OR [95% CI]: 3.1 [1.3-7.3], p = 0.004) and presence of PMO (OR [95% CI]:10 [4.1-23.9], p < 0.001) were shown to be significantly associated with the outcome. By using multivariate analysis, presence of MO (OR [95% CI]: 2.5 [1.0-6.2], p = 0.045) or of PMO (OR [95% CI]: 8.7 [3.6-21.1], p < 0.001), associated with GRACE score, were predictors of MACE. Presence of microvascular obstruction and persistent microvascular obstruction is very common in AMI patients even after successful reperfusion and is associated with a dramatically higher risk of subsequent cardiovascular events, beyond established prognostic markers. Moreover, our data suggest that the prognostic impact of PMO might be superior to MO.

Microvascular Obstruction Remains a Portent of Adverse Remodeling in Optimally Treated Patients With Left Ventricular Systolic Dysfunction After Acute Myocardial Infarction

“…9 -13 Late MO is considered to be a stronger predictor of LV remodeling than early MO. 13,14 Results of a recent study, however, showed that in patients with reperfused AMI, confirmed patency of the IRA, and a very high uptake of antiremodeling pharmacotherapy, the presence of late MO, though associated with greater infarct size, LV volumes, and lower LVEF at baseline, was not related to greater remodeling in comparison to patients without MO over a relatively short follow-up of 4 months. 15 We therefore examined the relationship between the presence of MO and a variety of infarct characteristics on LV outcomes after AMI in a cohort of patients enrolled in a clinical trial with a very high prescription rate of evidence-based secondary preventive therapies.…”

The Prognostic Implications of Cardiovascular Magnetic Resonance

“…MVO was associated with more pericardial effusions, pericarditis, adverse remodeling, and larger infarcts. Cochet et al 15 …”

Review article: Myocardial dynamic contrast-enhanced MR : vascular diseases and beyond

“…dial scars may be surrounded to a variable extent by tissues with impaired microvasculature (24,25). There is, to the best of our knowledge, no available data in the literature evaluating specifically how to differentiate microvascular from macrovascular obstruction in a LCEMR-DCEMR mismatch, resulting into systematic and potentially excessive referrals to catheter coronary angiography.…”