Impact of early vs. late microvascular obstruction assessed by magnetic resonance imaging on long-term outcome after ST-elevation myocardial infarction: a comparison with traditional prognostic markers
Impact of early vs. late microvascular obstruction assessed by magnetic resonance imaging on long-term outcome after ST-elevation myocardial infarction: a comparison with traditional prognostic markers
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DOI：
10.1093/eurheartj/ehq247
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发表时间：
2010-11-01
影响因子：
39.3
通讯作者：
Thiele, Holger
中科院分区：
文献类型：
--
作者：
de Waha, Suzanne;Desch, Steffen;Thiele, Holger
磁共振成像(MRI)评估的早期和晚期微血管阻塞(MO)是ST段抬高心肌梗死(STEMI)后联合临床终点的预后标志物。然而，关于硬性终点的数据有限，而且没有共识，这两种终点中哪一种最能预测临床结果。此外，尚不清楚MRI对MO的评估是否增加了独立于传统预后标记物的增量预后信息。STEMI患者在症状出现后12小时行直接血管成形术(n=438)和lt；12小时后进行MRI检查，中位数为指标事件后3天。分别于注射Gd后1分钟和15分钟(MO早期和晚期)测量微血管阻塞。中位时间19个月后进行临床随访。主要终点被定义为死亡、非致命性心肌再梗塞和充血性心力衰竭的复合体。与早期MO的存在和程度相反，在多变量COX回归分析中，晚期MO的存在和程度与多变量COX回归分析中的复合主要终点独立相关，这些因素调整了经皮冠状动脉介入治疗后的TIMI血流、ST段回落、TIMI风险评分、射血分数和梗塞范围。晚期MO的存在被认为是复合终点发生的最强独立预测因素(危险比4.23，95%可信区间1.73-10.34，P=0.002)。与早期MO相比，晚期MO的存在和程度是STEMI术后较强的独立预后指标。
Early and late microvascular obstruction (MO) assessed by magnetic resonance imaging (MRI) are prognostic markers for combined clinical endpoints after ST-elevation myocardial infarction (STEMI). However, there are only limited data for hard endpoints and no consensus exists which of the two best predicts clinical outcome. Furthermore, it is unclear whether the assessment of MO by MRI adds incremental prognostic information independent of traditional outcome markers.STEMI patients reperfused by primary angioplasty (n = 438) < 12 h after symptom onset underwent MRI at a median of 3 days after the index event. Microvascular obstruction was measured 1 and 15 min after gadolinium injection (early and late MO). Clinical follow-up was conducted after a median of 19 months. The primary endpoint was defined as a composite of death, non-fatal myocardial re-infarction, and congestive heart failure. In contrast to the presence and extent of early MO, the presence and extent of late MO were independently associated with the composite primary endpoint in the multivariable Cox regression analysis adjusting for post-percutaneous coronary intervention TIMI-flow, ST-resolution, TIMI-risk score, ejection fraction, and infarct size. The presence of late MO was identified as the strongest independent predictor for the occurrence of the composite endpoint (hazard ratio 4.23, 95%CI 1.73-10.34, P = 0.002). Furthermore, the presence and extent of late MO provided an incremental prognostic value above the traditional prognostic markers.In contrast to early MO, the presence and extent of late MO are strong independent prognosticators after STEMI.www.ClinicalTrials.gov: NCT00299377.