title: Six-Year Prognostic Value of Microvascular Obstruction After Reperfused ST-Elevation Myocardial Infarction as Assessed by Contrast-Enhanced Cardiovascular Magnetic Resonance.
abstract: Although recent studies showed the prognostic value of cardiac magnetic resonance (CMR) parameters especially microvascular obstruction (MO) after reperfused ST-elevation myocardial infarction (STEMI), a study assessing their prognostic significance for long-term follow-up is missing so far. The objective of this study was to determine the prognostic impact of MO on long-term prognosis after reperfused first STEMI in a setting allocating CMR-assessed parameters to hard clinical events only. In 249 patients, CMR was performed after reperfused STEMI, and hereby, left ventricular ejection fraction (LVEF), infarct size (IS), and the amount of MO were quantified. Follow-up (median 6.0 years) was obtained regarding occurrence of major adverse cardiac events (MACE). MACE occurred more often in patients showing presence of MO (MO vs no MO: n = 61 [54%] vs n = 12 [9%], p <0.0001). By multivariate analysis, the extent of MO remained the strongest predictor (p <0.001) for occurrence of MACE and provided incremental prognostic value over clinical variables and LVEF (p = 0.028, c-index increase from 0.723 to 0.817). In conclusion, CMR-assessed MO proves predictive for assessment of 6-year prognosis in patients after reperfused first STEMI and provides incremental prognostic information over clinical variables and LVEF in a setting based on hard end points.
authors.affiliation: Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. Electronic address: dres.regenfus@t-online.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Regenfus
authors.affiliation: Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlundt
authors.affiliation: Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Krähner
authors.affiliation: Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Schönegger
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Adler
authors.affiliation: Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Ludwig
authors.affiliation: Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Werner G
authors.initials: WG
authors.lastname: Daniel
authors.affiliation: Department of Internal Medicine II, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schmid
mesh_terms: D003287:Contrast Media; D003326:Coronary Circulation / Q000502:physiology*; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013997:Time Factors
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA