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Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials.

Publication ,  Journal Article
de Waha, S; Patel, MR; Granger, CB; Ohman, EM; Maehara, A; Eitel, I; Ben-Yehuda, O; Jenkins, P; Thiele, H; Stone, GW
Published in: European heart journal
December 2017

Microvascular obstruction (MVO) is the underlying cause for the no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI). The association between MVO assessed by cardiac magnetic resonance imaging (CMR) and prognosis has not been convincingly demonstrated. We sought to determine the relationship between MVO assessed early after primary percutaneous coronary intervention (PCI) in STEMI and all-cause mortality, hospitalization for heart failure (HF), and reinfarction.We performed a pooled analysis using individual patient data from seven randomized primary PCI trials in which MVO was assessed within 7 days after reperfusion by CMR using late gadolinium enhancement imaging (n = 1688). Clinical follow-up was performed for at least 6 months after the index event. Median time to CMR after STEMI was 3 days [interquartile range (IQR) 2-4], and median duration of clinical follow-up was 365 days (IQR 188-374). Microvascular obstruction was present in 960 (56.9%) of patients, and median MVO (percent left ventricular myocardial mass) was 0.47% (IQR 0.00-2.54). A graded response was present between the extent of MVO (per 1.0% absolute increase) and subsequent mortality [Cox adjusted hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.09-1.19, P < 0.0001] and hospitalization for HF (Cox adjusted HR 1.08, 95% CI 1.05-1.12, P < 0.0001). Microvascular obstruction remained significantly associated with all-cause mortality even after further adjustment for infarct size (Cox adjusted HR 1.09, 95% CI 1.01-1.17, P = 0.03). MVO was not significantly related to subsequent reinfarction (P = 0.29).The presence and extent of MVO measured by CMR after primary PCI in STEMI are strongly associated with mortality and hospitalization for HF within 1 year.

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Published In

European heart journal

DOI

EISSN

1522-9645

ISSN

0195-668X

Publication Date

December 2017

Volume

38

Issue

47

Start / End Page

3502 / 3510

Related Subject Headings

  • ST Elevation Myocardial Infarction
  • Recurrence
  • Randomized Controlled Trials as Topic
  • Percutaneous Coronary Intervention
  • Myocardial Reperfusion
  • Middle Aged
  • Microcirculation
  • Male
  • Magnetic Resonance Angiography
  • Kaplan-Meier Estimate
 

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de Waha, S., Patel, M. R., Granger, C. B., Ohman, E. M., Maehara, A., Eitel, I., … Stone, G. W. (2017). Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials. European Heart Journal, 38(47), 3502–3510. https://doi.org/10.1093/eurheartj/ehx414
Waha, Suzanne de, Manesh R. Patel, Christopher B. Granger, E Magnus Ohman, Akiko Maehara, Ingo Eitel, Ori Ben-Yehuda, Paul Jenkins, Holger Thiele, and Gregg W. Stone. “Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials.European Heart Journal 38, no. 47 (December 2017): 3502–10. https://doi.org/10.1093/eurheartj/ehx414.
de Waha S, Patel MR, Granger CB, Ohman EM, Maehara A, Eitel I, Ben-Yehuda O, Jenkins P, Thiele H, Stone GW. Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials. European heart journal. 2017 Dec;38(47):3502–3510.
Journal cover image

Published In

European heart journal

DOI

EISSN

1522-9645

ISSN

0195-668X

Publication Date

December 2017

Volume

38

Issue

47

Start / End Page

3502 / 3510

Related Subject Headings

  • ST Elevation Myocardial Infarction
  • Recurrence
  • Randomized Controlled Trials as Topic
  • Percutaneous Coronary Intervention
  • Myocardial Reperfusion
  • Middle Aged
  • Microcirculation
  • Male
  • Magnetic Resonance Angiography
  • Kaplan-Meier Estimate