title: Clinical outcome and correlates of coronary microvascular obstruction in latecomers after acute myocardial infarction.
abstract: OBJECTIVE
  Microvascular obstruction (MVO) is associated with a worse prognosis in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). However, data about incidence, clinical outcome and correlates of MVO in latecomers after STEMI are still lacking.
  
  
  METHODS
  We prospectively enrolled consecutive patients that were latecomers after STEMI (symptoms onset >12h) undergoing PCI. We performed an angiographic analysis to assess the occurrence of MVO [defined as TIMI flow grade ≤2 or 3 with a myocardial blush grade <2]. Moreover, we performed a clinical and echocardiographic follow-up to assess the occurrence of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, myocardial infarction and rehospitalization for heart failure, and to evaluate left ventricle remodelling.
  
  
  RESULTS
  Seventy-eight patients were enrolled [mean age 67.58±11.72years, 57 (73%) male; mean time of symptom onset 23.14±16.06h] with a mean follow-up time of 29.7±14.1months. MVO occurred in 39 (50%) patients. Patients with MVO had a higher rate of MACE [18 (46%) vs. 3 (8%), p<0.001] and LV remodelling [25 (64%) vs. 6 (15%), p<0.001] compared with patients without MVO. By multivariable Cox regression MVO and left anterior descending artery were independent predictors of MACE.
  
  
  CONCLUSIONS
  Latecomers after STEMI have a high risk to develop MVO that is related to an adverse prognosis. Appropriate management and follow-up strategies should be implemented in such high-risk patients group.
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy; Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Montone
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: gniccoli73@hotmail.it.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Minelli
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fracassi
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vetrugno
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Aurigemma
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012720:Severity of Illness Index; D016019:Survival Analysis; D020257:Ventricular Remodeling