title: 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.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  In contrast to early MO, the presence and extent of late MO are strong independent prognosticators after STEMI. www.ClinicalTrials.gov: NCT00299377.
authors.affiliation: Department of Internal Medicine - Cardiology, University of Leipzig - Heart Centre, Leipzig, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.forename: Johannes
authors.initials: J
authors.lastname: Zachrau
authors.forename: Anja
authors.initials: A
authors.lastname: Leuschner
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D015415:Biomarkers / Q000097:blood; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers