Impact of Persistent Microvascular Obstruction Late After STEMI on Adverse LV Remodeling: A Cardiac Magnetic Resonance (CMR) Study
Authors' conclusion
MVO persists in a small percentage of patients in chronic phase after STEMI and exerts deleterious effects in terms of LV remodeling.
Study context
- Population
- Patients with reperfused STEMI undergoing CMR at 1 week and late after infarction
- Participants
- 471 patients
- Exposure
- Persistent microvascular obstruction (MVO) vs MVO only at 1 week vs no MVO
- No MVOn = 262reference
- MVO only at 1 weekn = 179
- Persistent MVOn = 30
- Outcome
- Adverse LV remodeling (relative increase >15% at follow-up CMR) of LVEDVI and left ventricular end-systolic volume index (LVESVI)
- Follow-up
- 198 (IQR: 167-231) days
Methodological detailspropensity-score matched
- Propensity-score matched
Main finding
As reported in the abstract
ALVR (relative increase >15% in LVEDVI or LVESVI at follow-up CMR) · 198 (IQR: 167-231) days after infarction
ALVR-LVEDVI
P = 0.003
ALVR-LVESVI
P < 0.001
- Persistent MVO at follow-up independently associated with ΔLVEDVI after adjustment
- P < 0.001
- Persistent MVO at follow-up independently associated with ΔLVESVI after adjustment
- P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | No MVO | MVO only at 1 week | Persistent MVO | P value | |
|---|---|---|---|---|---|
| ALVR, propensity-score matched (30 vs 30) | |||||
| ALVR-LVEDVI | Not reported in the abstract | 12% | 50% | P = 0.003 | No MVO: not reported in the abstract |
| ALVR-LVESVI | Not reported in the abstract | 12% | 53% | P = 0.001 | No MVO: not reported in the abstract |
- Adverse left ventricular remodeling (ALVR), propensity-score matched (30 vs 30): 1:1 propensity score-matched on CMR variables
MVO occurrence
- One-week MVO
- 209 patients (44%)
- Persistent MVO
- 30 (6%)
Predictors of MVO magnitude at follow-up CMR
- Extent of MVO at 1 week independently associated
- P = 0.026
- Intramyocardial hemorrhage at 1 week independently associated
- P = 0.001
Original publication
Impact of Persistent Microvascular Obstruction Late After STEMI on Adverse LV Remodeling: A CMR Study. JACC Cardiovasc Imaging. Published 12 April 2023. doi:10.
Summarised from the published abstract; every number is checked against it