Coronary disease & ACSCohort study
Platelet activation and thrombosis in microvascular obstruction
- single-centre observational cohort study
Authors' conclusion
MVO following ST-segment elevation myocardial infarction is universally associated with myocardial platelet activation, extending beyond structural abnormalities identified by cardiac MR. These findings are consistent with an important mechanistic contribution of platelet-mediated microvascular thrombosis to no-reflow and MVO, highlighting a potentially targetable biological pathway in a condition for which effective therapies remain elusive.
Study context
- Population
- Patients with acute anterior ST-segment elevation myocardial infarction undergoing hybrid cardiac [18F]GP1 positron emission tomography (PET) and magnetic resonance (MR) imaging
- Participants
- 100 patients
- Exposure
- Myocardial [18F]GP1 uptake compared with MR measures of infarction, microvascular obstruction (MVO) and adverse ventricular remodelling
Main finding
As reported in the abstract
Participants with increased uptake
44%
TBRmax
1.89 ± 0.50
Observational data: associations, not effects.
Further findings
Myocardial [18F]GP1 uptake in patients with MR-defined MVO
- All patients with MR-defined MVO demonstrated myocardial [18F]GP1 uptake
- 40
Myocardial [18F]GP1 uptake burden vs MR-defined burden of MVO
- Correlation
- ρ = 0.84; P < 0.001
- Uptake burden exceeded MR-defined MVO burden by
- 18%
Associations of myocardial [18F]GP1 uptake
- Associated with infarct size, lower left ventricular ejection fraction and longer time-to-reperfusion
Independent association of MVO: angiographic no-reflow
- adjusted odds ratio
- 16.15; P < 0.001
- strongest independent association of MVO
Persistent myocardial [18F]GP1 uptake · follow up
- Persistent uptake
- 22%, 7/32
- Associated with lower left ventricular ejection fraction
Resolution of cardiac MR-defined MVO · follow-up
- Resolution of MVO
- 78%
- Universally concordant with resolution of myocardial [18F]GP1 uptake
Original publication
Summarised from the published abstract; every number is checked against it