title: Incidence, predictors, and prognostic value of intramyocardial hemorrhage lesions in ST elevation myocardial infarction.
abstract: BACKGROUND
  Intra myocardial hemorrhage lesions (IMH) are underdiagnosed complication of ST elevation myocardial infarction (STEMI). We sought to determine the incidence, predictors and the prognostic value of IMH in STEMI using cardiac MR imaging (CMR) techniques.
  
  
  METHODS
  We screened for inclusion consecutive patients with STEMI treated by percutaneous coronary intervention (PCI) within the first 12 hr of evolution. IMH lesions were identified on T2-weighted sequences on CMR between days 4 and 8 after PCI. Adverse cardiac events were defined as a composite of death + severe ventricular arrhythmias + acute coronary syndrome + acute heart failure.
  
  
  RESULTS
  N = 114 patients were included and n = 11 patients (10%) presented IMH lesions. Patients with IMH lesions had a larger myocardial infarction extent (25.6 ± 1.8 vs. 13.5 ± 1.0 % LV mass, P < 0.01), microvascular obstructive lesions extent (4.6 ± 1.0 vs. 1.3 ± 0.3% LV mass, P < 0.01) and lower LV ejection fraction (40.7 ± 2.3% vs. 50.7 ± 1.3%, P < 0.01). The value of glycemia at admission was an independent predictor of IMH development (Odd ratio 1.8 [1.1-2.8] per mmol l(-1), P = 0.01). The incidence of adverse cardiac events was higher in the IMH group than in the non-IMH group during the first year following STEMI (P = 0.01, log-rank analysis). Cox regression analysis identified the presence of IMH lesions as an independent predictor of adverse clinical outcome (Hazard Ratio = 2.8 [1.2-6.8], P = 0.02).
  
  
  CONCLUSIONS
  Our study indicates that IMH is a rare but severe finding in STEMI, associated with a larger myocardial infarction and a worse clinical outcome. Per-PCI glycemia might influence IMH development.
authors.affiliation: Department of Cardiology, CHU Nord, University of Marseille School of Medicine, Marseille, France. n.amabile@ccml.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
authors.forename: Alexis
authors.initials: A
authors.lastname: Jacquier
authors.forename: Anes
authors.initials: A
authors.lastname: Shuhab
authors.forename: Jean
authors.initials: J
authors.lastname: Gaudart
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Bartoli
authors.forename: Franck
authors.initials: F
authors.lastname: Paganelli
authors.forename: Guy
authors.initials: G
authors.lastname: Moulin
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005602:France; D006470:Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome