Effect of microvascular obstruction on left ventricle function and prognosis in patients with ST-segment elevation myocardial infarction

doi:10.3969/j.issn.1674-8115.2021.02.008

Abstract

Abstract: Objective

·To investigate the effect of microvascular obstruction (MVO) on left ventricle function and prognosis in patients with ST-segment elevation myocardial infarction (STEMI) by using cardiac magnetic resonance (CMR) technique.

Methods

·A total of 124 patients with STEMI in the Department of Cardiology of Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2016 to December 2017 were enrolled. The percentage of myocardial infarction size, the percentage of myocardial MVO size and left ventricle function after reperfusion were evaluated by CMR technique. According to the percentage of myocardial MVO size, the patients were divided into MVO (+) group and MVO (-) group. The baseline characteristics, blood biochemical indexes and CMR indexes of the two groups were compared. The MVO (+) group was further divided into 4 subgroups according to the quartiles of the percentage of myocardial infarction size. Pearson correlation analysis was used to explore the correlation between the percentage of myocardial MVO size and left ventricular ejection fractions (LVEF) in each subgroup. The incidence of adverse events within 30 days was observed. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of the percentage of myocardial MVO size for adverse events.

Results

·The white blood cell count, creatine phosphokinase, creatine kinase MB, cardiac troponin I and total cholesterol in the MVO (+) group were significantly higher than those in the MVO (-) group (all P<0.05), while baseline characteristics showed no significant difference. LVEF in the MVO (+) group was lower than that in the MVO (-) group (P=0.000). Pearson correlation analysis showed that the percentage of myocardial MVO size was negatively correlated with LVEF (all P<0.05). ROC curve showed that the area under the curve of the percentage of myocardial MVO size in the prediction of adverse events within 30 days was 0.889 (95%CI 0.823?0.975), and the sensitivity and specificity of the percentage of myocardial MVO size were more higher than that of the percentage of myocardial infarction size.

Conclusion

·The left ventricle function and prognosis in STEMI patients with MVO are worse, suggesting that more attention should be paid to the clinical intervention for such patients.

Key words: cardiac magnetic resonance (CMR), ST-segment elevation myocardial infarction (STEMI), microvascular obstruction (MVO), left ventricle function, prognosis

CLC Number:

R543.3

Pei-kun HU, Jie HE, Lian-ming WU, Heng GE, Jian-rong XU, Jun PU. Effect of microvascular obstruction on left ventricle function and prognosis in patients with ST-segment elevation myocardial infarction[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(2): 173-179.

Figures/Tables 7

TrendMD

References 25

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Characteristic	MVO (+) group (N=82)	MVO (-) group (N=42)	P value
Age/year	58.6±7.9	58.7±8.4	0.958
Gender/n (%)			0.098
Male	76 (92.7)	34 (81.0)
Female	6 (7.3)	8 (19.0)
Smoking history/n (%)	65 (79.3)	30 (71.4)	0.329
Drinking history/n (%)	22 (26.8)	13 (31.0)	0.629
Hypertension/n (%)	48 (58.5)	19 (45.2)	0.160
Diabetes mellitus/n (%)	30 (36.6)	12 (28.6)	0.372
Hypercholesterolemia/n (%)	46 (56.1)	19 (45.2)	0.252
Previous angina/n (%)	42 (51.2)	25 (59.5)	0.380
Renal dysfunction/n (%)	3 (3.7)	0 (0)	0.524
Previous stroke/n (%)	0 (0)	1 (2.4)	0.732
Pain-to-balloon time/h	5.5±3.2	4.9±1.6	0.166
Reperfusion therapy/n (%)			1.000
PPCI	41 (50.0)	21 (50.0)
PCI after thrombolysis	41 (50.0)	21 (50.0)
Culprit vessel/n (%)			0.398
LAD	47 (57.3)	25 (59.5)
LCX	10 (12.2)	2 (4.8)
RCA	25 (30.5)	15 (35.7)
Killip class/n (%)			1.000
Ⅰ	74 (90.2)	38 (90.5)
Ⅱ	7 (8.5)	3 (7.1)
Ⅲ	1 (1.2)	1 (2.4)
Time delay from the onset of chest pain to CMR/d	5.2±2.2	5.3±1.8	0.863

Characteristic	MVO (+) group (N=82)	MVO (-) group (N=42)	P value
Age/year	58.6±7.9	58.7±8.4	0.958
Gender/n (%)			0.098
Male	76 (92.7)	34 (81.0)
Female	6 (7.3)	8 (19.0)
Smoking history/n (%)	65 (79.3)	30 (71.4)	0.329
Drinking history/n (%)	22 (26.8)	13 (31.0)	0.629
Hypertension/n (%)	48 (58.5)	19 (45.2)	0.160
Diabetes mellitus/n (%)	30 (36.6)	12 (28.6)	0.372
Hypercholesterolemia/n (%)	46 (56.1)	19 (45.2)	0.252
Previous angina/n (%)	42 (51.2)	25 (59.5)	0.380
Renal dysfunction/n (%)	3 (3.7)	0 (0)	0.524
Previous stroke/n (%)	0 (0)	1 (2.4)	0.732
Pain-to-balloon time/h	5.5±3.2	4.9±1.6	0.166
Reperfusion therapy/n (%)			1.000
PPCI	41 (50.0)	21 (50.0)
PCI after thrombolysis	41 (50.0)	21 (50.0)
Culprit vessel/n (%)			0.398
LAD	47 (57.3)	25 (59.5)
LCX	10 (12.2)	2 (4.8)
RCA	25 (30.5)	15 (35.7)
Killip class/n (%)			1.000
Ⅰ	74 (90.2)	38 (90.5)
Ⅱ	7 (8.5)	3 (7.1)
Ⅲ	1 (1.2)	1 (2.4)
Time delay from the onset of chest pain to CMR/d	5.2±2.2	5.3±1.8	0.863

Index	MVO (+) group (N=82)	MVO (-) group (N=42)	P value
Blood biochemical index
CRP/(mg·L^-1)	5.92 (1.52, 22.03)	3.95 (2.42, 12.53)	0.720
WBC/(×10⁹·L^-1)	11.95 (10.01, 13.95)	10.21 (7.92, 12.85)	0.016
Hb/(g·L^-1)	145.23±16.16	140.31±14.37	0.109
PLT/(×10⁹·L^-1)	195.85±48.77	211.36±49.15	0.097
FBG/(g·L^-1)	2.81±0.71	2.88±0.58	0.588
PT/s	10.70 (10.00, 11.83)	10.60 (10.10, 11.70)	0.755
APTT/s	32.10 (28.70, 36.30)	33.65 (29.15, 36.18)	0.748
INR	0.94 (0.88, 0.99)	0.93 (0.88, 1.01)	0.919
Scr/(μmol·L^-1)	71.70±19.35	70.11±14.27	0.640
BUN/(mmol·L^-1)	5.60±1.65	5.32±1.76	0.375
Glu/(mmol·L^-1)	5.72 (5.09, 6.61)	5.29 (4.80, 6.16)	0.093
TAG/(mmol·L^-1)	1.37 (0.96, 2.51)	1.31 (0.95, 1.63)	0.240
TC/(mmol·L^-1)	5.21±1.10	4.77±1.05	0.039
HDL-Ch/(mmol·L^-1)	1.17±0.26	1.16±0.27	0.920
LDL-Ch/(mmol·L^-1)	3.21±0.86	3.09±0.88	0.450
CPK/(U·L^-1)	3 632.00 (2 547.00, 5 151.25)	1 565.00 (1 074.50, 3 228.00)	0.000
CK-MB/(U·L^-1)	370.75 (241.43, 480.45)	201.60 (120.95, 288.25)	0.000
cTnI/(ng·mL^-1)	26.34 (1.54, 80.85)	10.33 (0.93, 28.40)	0.022
BNP/(pg·mL^-1)	101.50 (37.95, 275.00)	93.80 (17.38, 203.00)	0.202
CMR index
LVEF/%	47.07±8.94	53.95±5.79	0.000
Percentage of myocardial infarction/%	23.09 (17.41, 30.46)	11.25 (6.40, 18.14)	0.000

Index	MVO (+) group (N=82)	MVO (-) group (N=42)	P value
Blood biochemical index
CRP/(mg·L^-1)	5.92 (1.52, 22.03)	3.95 (2.42, 12.53)	0.720
WBC/(×10⁹·L^-1)	11.95 (10.01, 13.95)	10.21 (7.92, 12.85)	0.016
Hb/(g·L^-1)	145.23±16.16	140.31±14.37	0.109
PLT/(×10⁹·L^-1)	195.85±48.77	211.36±49.15	0.097
FBG/(g·L^-1)	2.81±0.71	2.88±0.58	0.588
PT/s	10.70 (10.00, 11.83)	10.60 (10.10, 11.70)	0.755
APTT/s	32.10 (28.70, 36.30)	33.65 (29.15, 36.18)	0.748
INR	0.94 (0.88, 0.99)	0.93 (0.88, 1.01)	0.919
Scr/(μmol·L^-1)	71.70±19.35	70.11±14.27	0.640
BUN/(mmol·L^-1)	5.60±1.65	5.32±1.76	0.375
Glu/(mmol·L^-1)	5.72 (5.09, 6.61)	5.29 (4.80, 6.16)	0.093
TAG/(mmol·L^-1)	1.37 (0.96, 2.51)	1.31 (0.95, 1.63)	0.240
TC/(mmol·L^-1)	5.21±1.10	4.77±1.05	0.039
HDL-Ch/(mmol·L^-1)	1.17±0.26	1.16±0.27	0.920
LDL-Ch/(mmol·L^-1)	3.21±0.86	3.09±0.88	0.450
CPK/(U·L^-1)	3 632.00 (2 547.00, 5 151.25)	1 565.00 (1 074.50, 3 228.00)	0.000
CK-MB/(U·L^-1)	370.75 (241.43, 480.45)	201.60 (120.95, 288.25)	0.000
cTnI/(ng·mL^-1)	26.34 (1.54, 80.85)	10.33 (0.93, 28.40)	0.022
BNP/(pg·mL^-1)	101.50 (37.95, 275.00)	93.80 (17.38, 203.00)	0.202
CMR index
LVEF/%	47.07±8.94	53.95±5.79	0.000
Percentage of myocardial infarction/%	23.09 (17.41, 30.46)	11.25 (6.40, 18.14)	0.000

Adverse event	MVO (+) group (N=82)	MVO (-) group (N=42)	P value
All-cause mortality/n (%)	1 (1.2)	0 (0)	1.000
Myocardial reinfarction/n (%)	2 (2.4)	0 (0)	0.548
Recurrent angina/n (%)	8 (9.8)	3 (7.1)	0.880
Heart failure/n (%)	14 (17.1)	1 (2.4)	0.018