Impact of Early ST-Segment Changes on Cardiac Magnetic Resonance-Verified Intramyocardial Haemorrhage and Microvascular Obstruction in ST-Elevation Myocardial Infarction Patients.
The aim of this study was to explore the significance of different ST-segment changes before and after percutaneous coronary intervention (PCI), in relation to cardiac magnetic resonance (CMR)-verified microvascular obstruction (MVO) along with intramyocardial hemorrhage (IMH) in ST-elevation myocardial infarction (STEMI) patients.This study enrolled 108 STEMI patients who received primary PCI and had no contraindication of CMR investigation. Sum ST-segment elevation (STE), maximal STE on admission and sum ST-segment resolution (STR), and single-lead STR and residual STE at 60 minutes after primary PCI were assessed. MVO and IMH were determined by contrast-enhanced CMR.Patients were classified into 3 groups: 30 patients with MVO(-)/IMH(-), 25 with MVO(+)/IMH(-), and 53 with MVO(+)/IMH(+). Sum STE (P = 0.001), maximal STE (P < 0.001), and residual STE (P = 0.025) were highest and single-lead STR was lowest (P = 0.044) in the MVO(+)/IMH(+) group. Receiver operator characteristics curve analysis revealed that maximal STE was the most powerful factor for distinguishing between MVO(+) and MVO(-) patients (optimal threshold = 0.5 mV, area under the curve, AUC = 0.718, P < 0.001), or IMH(+) and IMH(-) patients (optimal threshold = 0.5 mV, AUC = 0.697, P < 0.001). In multivariate analysis, maximal STE was identified as the most powerful independent predictor of MVO (odds ratio [OR] = 4.30, P < 0.001) and IMH (OR = 2.44, P = 0.001), whereas sum STE was the strongest correlate of both the number of MVO segments (r = 0.42, P < 0.001) and IMH segments (r = 0.43, P < 0.001).The presence of MVO and IMH in infarcted tissue was relevant to ST-segment changes in STEMI patients. Maximal STE was a powerful independent predictor of the presence of MVO and IMH, whereas sum STE was a strong correlate of the number of MVO and IMH segments.
From the Department of Cardiology (SD, ZL, HG, Z-QO, Y-LC, FY, L-CK, MJ, BH, JP); and Department of Radiology (A-LA), Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Song
S
Ding
Zheng
Z
Li
Heng
H
Ge
Zhi-Qing
ZQ
Qiao
Yi-Lin
YL
Chen
Ao-Lei
AL
Andong
Fan
F
Yang
Ling-Cong
LC
Kong
Meng
M
Jiang
Ben
B
He
Jun
J
Pu
D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000473:pathology; D006470:Hemorrhage / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D017566:Microvascular Angina / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D015588:Observer Variation; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity