Coronary Culprit Lesion Location and Intramyocardial Hemorrhage in STEMI

doi:10.1161/circimaging.125.019364

Coronary disease & ACSCohort study

Coronary Culprit Lesion Location and Intramyocardial Hemorrhage in STEMI

Circ Cardiovasc ImagingPublished 28 Apr 2026

Cohort analysis of patients with STEMI undergoing cardiac magnetic resonance imaging

Read the original article ↗

Authors' conclusion

CX infarctions were independently associated with the highest risk of IMH. The low prevalence of collateral circulation may contribute to this susceptibility. These findings define CX infarctions as a high-risk phenotype that may benefit from targeted cardioprotective strategies.

Study context

Population: Patients with ST-segment-elevation myocardial infarction undergoing cardiac magnetic resonance imaging, including T2* mapping, at 4 (interquartile range, 3–5) days after infarctionpatients with ST-segment-elevation myocardial infarction undergoing cardiac magnetic resonance imaging
Participants: 767 patients

Exposure: Coronary culprit lesion location and intramyocardial hemorrhage (IMH)
right coronary arteryn = 286
left anterior descending arteryn = 351
circumflex artery (CX)n = 109
Outcome: Presence of IMH on cardiac magnetic resonance

Main finding

As reported in the abstract

Odds ratio

1.27

95% CI 1.07–1.50

P = 0.005

Events by group

right coronary artery27%76/286 of 286

left anterior descending artery39%136/351 of 351

circumflex artery (CX)44%48/109 of 109

CX infarction

odds ratio 1.27 (95% CI 1.07–1.50); P = 0.005

IMH detected, all patients: 265 (35%)
Difference across culprit vessels: P < 0.001
Segment 11 (CX proximal), highest risk for IMH: n=23/41, 56%
Segment 1 (right coronary artery proximal), lowest risk for IMH: n=22/85, 26%

Observational data: associations, not effects.

Further findings

Collateral flow

right coronary artery41%

left anterior descending artery29%

circumflex artery (CX)14%

Major adverse cardiac events (all-cause mortality, reinfarction, new congestive heart failure), exploratory clinical end point · 12 months

right coronary artery2%

left anterior descending artery6%

circumflex artery (CX)7%

Collateral flow: P <0.001
Major adverse cardiac events (all-cause mortality, reinfarction, new congestive heart failure), exploratory clinical end point: P =0.039

Baseline characteristics

Median age: 59 (interquartile range, 53-67) years
Female: 19% (n=144)

Original publication

Coronary Culprit Lesion Location and Intramyocardial Hemorrhage in STEMI. Circ Cardiovasc Imaging. Published 28 April 2026. doi:10.1161/circimaging.125.019364

Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it