Clinical study of coronary microvascular obstruction based on cardiac magnetic resonance assessment on prognosis after emergency percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction
10.3969/j.issn.1004-8812.2025.06.005
- VernacularTitle:基于心脏磁共振评估的冠状动脉微血管阻塞对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后预后的临床研究
- Author:
Hui ZHANG
1
;
Li WANG
;
Hai-juan SHANGGUAN
;
Min WANG
;
Hua YAN
Author Information
1. 武汉科技大学附属武汉亚洲心脏病医院心内科,湖北武汉 430022;武汉科技大学医学部医学院,湖北武汉 430065
- Publication Type:Journal Article
- Keywords:
Acute ST-segment elevation myocardial infarction;
Coronary microcirculation dysfunction;
Microvascular obstruction;
Cardiac magnetic resonance imaging;
Major adverse cardiovascular events
- From:
Chinese Journal of Interventional Cardiology
2025;33(6):327-333
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess coronary microvascular obstruction(MVO)after percutaneous coronary intervention in(PCI)patients with acute ST-segment elevation myocardial infarction(STEMI)and to investigate its value for patient prognosis.Methods We enrolled 97 patients who were hospitalized for acute STEMI at Wuhan Asia Heart Hospital from May 2021 to June 2024,underwent emergency PCI during hospitalization,and completed cardiac magnetic resonance(CMR)at a median of 7(5,8)days after the procedure.Patients were classified into MVO group(n=58)and non-MVO group(n=39)according to the results of CMR.Cox regression was used to analyse predictors of adverse events after PCI.Patients were followed for a median of 11.5(8.5,24.5)months for the occurrence of major adverse cardiovascular events(MACE,a composite outcome including readmission for heart failure,recurrent myocardial infarction,target vessel restenosis,target vessel revascularisation,and cardiac death)and secondary endpoint events(left ventricular remodelling,non-cardiac death).Results MVO was evidenced in 58 patients(59.79％).Multifactorial Cox regression analysis showed that MVO(HR 7.024,95％CI 1.408-35.027,P=0.017)and the proportion of inactive myocardium to the left ventricle(HR 1.066,95％CI 1.014-1.121,P=0.012)were the independent predictors factors for the incidence of adverse events in STEMI patients after PCI.The median follow-up time was 11.5(8.5,24.5)months.There was no statistically significant difference in the incidence of MACE between the MVO group and the non-MVO group(P=0.347).However,the MVO group had a higher incidence of secondary endpoints(32.76％ vs.2.56％,P＜0.001)and a higher incidence of left ventricular remodeling(29.31％ vs.2.56％,P＜0.001).Kaplan Meier survival analysis showed that the prognosis of the non-MVO group was significantly better than that of the MVO group(Log-rank P＜0.001).Conclusions MVO after PCI in patients with acute STEMI is a good predictor of clinical prognosis.
