Clinical predictors of microvascular obstruction by delayed enhanced CMR in STEMI patients
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POSTER PRESENTATION
Open Access
Clinical predictors of microvascular obstruction by delayed enhanced CMR in STEMI patients José T Ortiz Pérez1*, María Manuela Izquierdo Gómez2, L Bakhos2, Ander Regueiro1, Teresa María De Caralt3, Rosario Jesus Perea3, Susana Prat1, Daniel C Lee2, Xavier Bosch1, Edwin Wu2 From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Objective To identify significant predictors of the presence and extent of microvascular obstruction in the acute phase of STEMI patients. Background The presence of microvascular obstruction (MO) on delayed enhanced cardiac magnetic resonance (DECMR) imaging is associated with adverse remodeling and poor prognosis after STEMI. Identifying which patients that may develop MO prior to undergoing acute mechanical reperfusion maybe important in managing patients for more direct interventions. We sought to evaluate clinical predictors of MO as depicted by DECMR. Methods We included 255 patients with their first STEMI reperfused with primary percutaneous intervention. A standard DE-CMR was performed acutely at a mean of 3.9±2.0 days after admission. Clinical risk factors, time to reperfusion as well as angiographic variables were prospectively collected. The angiographic area at risk and the infarct size as a % of the left ventricle (LV) were computed. The number of segments with MO, defined as an area of hypoenhancement surrounded by delayed enhancement on DE-CMR, were summed to calculate MO extent. Results MO was present in 44% of the cases. Patients with MO had 3.1 ± 1.8 segments with MO. Different variables
Table 1 Mean number of segments with MO Yes
No
P value
Male gender
1.5±2.0
0.7±1.5
0.003
Diabetes
1.9±1.9
1.2±1.9
0.009
Anterior Location
1.6±2.2
0.8±1.3
0.004
Initial TIMI flow 0/1 Absent Collaterals
1.5±2.0 1.5±2.1
0.8±1.4 0.8±1.4
0.03 0.02
were analyzed but only male gender, diabetes, infarct location anterior, initial TIMI 0/1 flow and absent collaterals (Rentrop’s grades 0/1) were associated with an increased MO incidence as shown in table 1 and had greater number of segments with MO. In addition, greater number of MO segments signifiantly correlated with a larger angiographic area at risk (P=0.005) and infarct size (P
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