Microvascular perfusion in infarcted and remote myocardium after successful primary PCI: angiographic and CMR findings

摘要

ObjectivesThe aim of this study was to investigate the association between TIMI myocardial perfusion (TMP) grading acute and cardiac magnetic resonance (CMR) first-pass perfusion early and at 4 months in patients with ST-segment-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).Material and methodsOne hundred ninety-eight STEMI patients were recruited from the POSTEMI study. TMP grade was assessed after PCI; CMR was performed at day 2 and after 4 months. Signal intensity was measured on first-pass perfusion images, and a maximum contrast enhancement index (MCE) was calculated.ResultsPatients with TMP grade 2-3 (n = 108) after PCI had significantly better EF (59 10 vs. 51 13, p 0.001) and smaller infarct volume (12 8 vs. 19 12 %, p 0.001) at 4 months compared with patients with TMP grade 0-1 (n = 81). MCE in the infarcted (MCEi) and remote myocardium (MCEr) improved from early to follow-up CMR, MCEi from 94 +/- 56 to 126 +/- 59, p 0.001, and MCEr from 112 +/- 51 to 127 +/- 50, p 0.001. In patients with the lowest CMR perfusion early, perfusion at 4 months remained decreased compared with the other groups, MCEi 108 +/- 75 vs. 133 +/- 51, p = 0.01, and MCEr 115 +/- 41 vs. 131 +/- 52, p = 0.047.Conclusion p id=Par5 TMP grade and early CMR first-pass perfusion were associated with CMR outcomes at 4 months. First-pass perfusion improved after 4 months in the infarcted and remote myocardium. However, in patients with the lowest CMR perfusion early, perfusion was still reduced after 4 months.Key Points center dot Cardiac magnetic resonance myocardial first-pass perfusion and TMP grading after successful PCI helps to assess risk in patients with ST elevation myocardial infarctiocenter dot Cardiac magnetic resonance myocardial first-pass perfusion shows that microvascular perfusion after ST elevation myocardial infarction can be impaired in both infarcted and non-infarcted myocardium.center dot Microvascular perfusion improves over time in patients with ST elevation myocardial infarction treated with primary PCI.