title: Role of pre-infarction angina and inflammatory status in the extent of microvascular obstruction detected by MRI in myocardial infarction patients treated by PCI.
abstract: OBJECTIVE
  The extent of microvascular obstruction (MVO) during myocardial infarction referred to as the "no-reflow phenomenon", may determine myocardial damage. Our study aimed to investigate the incidence and the influencing factors of MVO in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous intervention (PCI).
  
  
  METHODS
  Using contrast-enhanced MRI, microvascular obstruction was defined as early hypoenhancement. Contrast defects were scored from 0 (no hypoenhancement) to 3 (strong hypoenhancement). 50 patients (56+/-11 years) with STEMI underwent PCI. Contrast-enhanced MRI (6+/-2 days after STEMI) and biochemical parameters were evaluated.
  
  
  RESULTS
  Microvascular obstruction (score 1 to 3) was observed in 90% of the patients and major microvascular obstruction (score 2-3) in 54%. In univariate analysis, leukocytes and CRP levels were associated with MVO, whereas pre-infarction angina and prior medication by aspirin or calcium channel antagonist appeared protective. Microvascular obstruction intensity positively correlated with baseline inflammation status assessed by C-reactive protein and leukocytes (rho=0.43 and rho=0.44; p=0.003), the peak of CK (rho=0.56; p=0.01) or Troponin I (rho=0.59; p=0.01) and negatively correlated with LVEF (rho=-0.44; p=0.002). Multivariate analysis identified the absence of pre-infarction angina as the only independent predictor for microvascular obstruction (odds ratio, 8.35, 95% confidence interval 1.27-54.71; p=0.027).
  
  
  CONCLUSIONS
  MRI-detected microvascular obstruction has a high incidence in patients with STEMI treated by primary PCI and determines post-MI LVEF even in patients with post PCI TIMI 3 flow score. Pre-infarction angina appears to be an independent determinant of the extent of MVO detected by MRI.
authors.affiliation: Service de Cardiologie des Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg Cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Jesel
authors.forename: O
authors.initials: O
authors.lastname: Morel
authors.forename: P
authors.initials: P
authors.lastname: Ohlmann
authors.forename: P
authors.initials: P
authors.lastname: Germain
authors.forename: A
authors.initials: A
authors.lastname: Faure
authors.forename: C
authors.initials: C
authors.lastname: Jahn
authors.forename: P M
authors.initials: PM
authors.lastname: Coulbois
authors.forename: M
authors.initials: M
authors.lastname: Chauvin
authors.forename: P
authors.initials: P
authors.lastname: Bareiss
authors.forename: G
authors.initials: G
authors.lastname: Roul
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008833:Microcirculation; D017566:Microvascular Angina / Q000473:pathology* / Q000628:therapy*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology* / Q000628:therapy*