Microvascular obstruction is a major determinant of infarct healing and subsequent left ventricular remodelling following primary percutaneous coronary intervention

作者：Orn Stein^*; Manhenke Cord; Greve Ole Jacob; Larsen Alf Inge; Bonarjee Vernon Vijay Singh; Edvardsen Thor; Dickstein Kenneth

来源：European Heart Journal, 2009, 30(16): 1978-1985.

DOI：10.1093/eurheartj/ehp219

• ST elevation myocardial infarction
• Primary percutaneous coronary intervention
• Microvascular obstruction
• Infarct size infarct healing
• Left ventricular remodelling
• Cardiac magnetic resonance
• Temporal relationships

We studied the time-dependent relationships between microvascular obstruction (MO), infarct size, and left ventricular (LV) remodelling after acute myocardial infarction (MI).
Forty-two consecutive patients with first-time ST-elevation MI, single-vessel disease, successfully treated with primary percutaneous coronary intervention (PCI) were included. Microvascular obstruction, infarct size, and LV remodelling were assessed by cardiac magnetic resonance. Cardiac magnetic resonance was performed at: 2 days, 1 week, 2 months, and 1 year following PCI. Microvascular obstruction was assessed by first-pass perfusion. Patients were divided into three groups according to the presence or absence of MO at 2 days and 1 week: no detectable MO at any time point (11 patients), MO detectable only at 2 days (16 patients), and MO detectable both at 2 days and 1 week (15 patients). In multivariable analysis adjusting for infarct size at 2 days, detectable MO at 1 week was an independent predictor (P = 0.003) of infarct size at 1 year follow-up, associated with adverse infarct healing, adverse LV remodelling, increased LV volumes, and lower ejection fractions when compared with the rest of the cohort.
Microvascular obstruction is an important determinant of infarct healing. The effect of MO on infarct size translated into distinct patterns of LV remodelling during long-term follow-up.
Clinical study no.: NCT 00465868.

• 出版日期2009-8