Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance.
Myocardial Hemorrhage After Acute Reperfused ST-Segment-Elevation Myocardial Infarction: Relation to Microvascular Obstruction and Prognostic Significance.
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DOI：
10.1161/circimaging.115.004148
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发表时间：
2016-01
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通讯作者：
Berry C
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作者：
Carrick D;Haig C;Ahmed N;McEntegart M;Petrie MC;Eteiba H;Hood S;Watkins S;Lindsay MM;Davie A;Mahrous A;Mordi I;Rauhalammi S;Sattar N;Welsh P;Radjenovic A;Ford I;Oldroyd KG;Berry C
补充数字内容可在文本中找到。ST段抬高型心肌梗死（MI）的冠状动脉再灌注治疗的成功通常受到无法恢复微血管灌注的限制。我们对MI后2天（n = 286）和6个月（n = 228）接受心脏磁共振的ST段抬高再灌注MI患者进行了前瞻性队列研究。还进行了一系列成像时程研究（n = 30名参与者; 4次心脏磁共振扫描）：再灌注后4至12小时、2天、10天和7个月。心肌出血代表低信号梗死核心，T2 * 值<20 ms。用晚期钆增强评估微血管阻塞。不良重构定义为6个月时左心室舒张末期容积增加≥ 20%。在随访期间评估出院后心血管死亡或心力衰竭事件。245例患者具有可评价的T2 * 数据（平均值±年龄，58 [11]岁; 76%为男性）。MI后2天的心肌出血与MI严重程度和炎症的临床特征相关。心肌出血是不良重构的多变量相关因素（比值比[95%置信区间]：2.64 [1.07 - 6.49]; P = 0.035）。10例（4%）患者有心血管原因死亡或出院后发生心力衰竭事件，心肌出血而非微血管阻塞与该复合不良结局相关（风险比，5.89; 95%置信区间，1.25 - 27.74; P = 0.025），包括校正基线左心室舒张末期容积后。在连续成像时程研究中，7例（23%）、13例（43%）、11例（33%）和4例（13%）患者在再灌注后4 - 12小时、2天、10天和7个月发生心肌出血。出血量（中位数[四分位距]，7.0 [4.9 - 7.5];左心室质量%）在第2天达到峰值（P <0.001），而微血管阻塞随着再灌注后时间的推移而减少。ST段抬高型心肌梗死后，心肌出血和微血管阻塞遵循不同的时间过程。与微血管阻塞相比，心肌出血与不良结局的关系更密切。URL：www.example.com。唯一标识符：NCT02072850。
Supplemental Digital Content is available in the text. The success of coronary reperfusion therapy in ST-segment–elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. We performed a prospective cohort study in patients with reperfused ST-segment–elevation MI who underwent cardiac magnetic resonance 2 days (n=286) and 6 months (n=228) post MI. A serial imaging time-course study was also performed (n=30 participants; 4 cardiac magnetic resonance scans): 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value of <20 ms. Microvascular obstruction was assessed with late gadolinium enhancement. Adverse remodeling was defined as an increase in left ventricular end-diastolic volume ≥20% at 6 months. Cardiovascular death or heart failure events post discharge were assessed during follow-up. Two hundred forty-five patients had evaluable T2* data (mean±age, 58 [11] years; 76% men). Myocardial hemorrhage 2 days post MI was associated with clinical characteristics indicative of MI severity and inflammation. Myocardial hemorrhage was a multivariable associate of adverse remodeling (odds ratio [95% confidence interval]: 2.64 [1.07–6.49]; P=0.035). Ten (4%) patients had a cardiovascular cause of death or experienced a heart failure event post discharge, and myocardial hemorrhage, but not microvascular obstruction, was associated with this composite adverse outcome (hazard ratio, 5.89; 95% confidence interval, 1.25–27.74; P=0.025), including after adjustment for baseline left ventricular end-diastolic volume. In the serial imaging time-course study, myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. The amount of hemorrhage (median [interquartile range], 7.0 [4.9–7.5]; % left ventricular mass) peaked on day 2 (P<0.001), whereas microvascular obstruction decreased with time post reperfusion. Myocardial hemorrhage and microvascular obstruction follow distinct time courses post ST-segment–elevation MI. Myocardial hemorrhage was more closely associated with adverse outcomes than microvascular obstruction. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850.