title: Proximal culprit lesion and coronary artery occlusion independently predict the risk of microvascular obstruction in acute myocardial infarction.
abstract: Microvascular obstruction (MO) and coronary flow have been independently described to have a high prognostic impact after acute myocardial infarction (AMI). Their interdependence has not been precisely elucidated, so far. Aim of this study was to investigate the impact of coronary flow on the occurrence of MO in patients with AMI. 336 patients with revascularized AMI were examined by cardiac magnetic resonance imaging. Patients were categorised into two groups based on the presence of MO. Procedural characteristics and marker of infarct size were analyzed. MO was present in 110 (33 %) and absent in 226 (67 %) patients. Both groups differed significantly regarding pre- and post-interventional thrombolysis in myocardial infarction (TIMI) flow. After multivariable regression analysis pre-interventional TIMI-flow 0, proximal culprit lesion, post-interventional TIMI-flow <III and creatine-kinase-myocardial band (CK-MB) remained strong independent predictors for MO. Odds ratios for pre-interventional TIMI-flow 0 were 2.31 (95 % CI 1.04-5.11, P = 0.034); for proximal culprit lesion 11.94 (95 % CI 5.70-25.01, P < 0.001); for post-interventional TIMI-flow III 0.28 (95 % CI 0.10-0.74, P = 0.010) and for CK-MB 1.50 (95 % CI 1.24-1.82, P < 0.001). Pre-interventional proximal coronary artery occlusion (TIMI 0) and insufficient post-interventional coronary reperfusion (TIMI-flow  <III) have a high impact on the occurrence of MO in AMI.
authors.affiliation: Department of Cardiology, Centre for Clinical Medicine, HELIOS Universitätsklinikum Wuppertal, University Hospital Witten/Herdecke, Arrenberger Str. 20, 42117, Wuppertal, Germany. nadine.abanador@helios-kliniken.de.
authors.forename: N
authors.initials: N
authors.lastname: Abanador-Kamper
authors.affiliation: Department of Diagnostic and Interventional Radiology, HELIOS Universitätsklinikum Wuppertal, University Hospital Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Kamper
authors.affiliation: Department of Cardiology, Centre for Clinical Medicine, HELIOS Universitätsklinikum Wuppertal, University Hospital Witten/Herdecke, Arrenberger Str. 20, 42117, Wuppertal, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Karamani
authors.affiliation: Department of Diagnostic and Interventional Radiology, HELIOS Universitätsklinikum Wuppertal, University Hospital Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Haage
authors.affiliation: Department of Cardiology, Centre for Clinical Medicine, HELIOS Universitätsklinikum Wuppertal, University Hospital Witten/Herdecke, Arrenberger Str. 20, 42117, Wuppertal, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Seyfarth
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Cardiac magnetic resonance imaging; Delayed gadolinium enhancement; Microvascular obstruction; Thrombolysis in myocardial infarction