Reinstadler Sebastian J, Stiermaier Thomas, Eitel Charlotte, Saad Mohammed, Metzler Bernhard, de Waha Suzanne, Fuernau Georg, Desch Steffen, Thiele Holger, Eitel Ingo
University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
J Cardiovasc Magn Reson. 2016 Nov 11;18(1):80. doi: 10.1186/s12968-016-0299-1.
Antecedent hypertension is associated with poor outcome in patients with ST-elevation myocardial infarction (STEMI). Whether differences in myocardial salvage, infarct size and microvascular injury contribute to the adverse outcome is unknown. We investigated the association between antecedent hypertension and cardiovascular magnetic resonance (CMR) parameters of myocardial salvage and damage in a multicenter CMR substudy of the AIDA-STEMI trial (Abciximab Intracoronary versus intravenously Drug Application in ST-elevation myocardial infarction).
We analyzed 792 consecutive STEMI patients reperfused within 12 h after symptom onset. Patients underwent CMR imaging for assessment of myocardial salvage, infarct size and microvascular obstruction within 10 days after infarction. Major adverse cardiac events (MACE) were recorded at 12-month follow-up.
Antecedent hypertension was present in 540 patients (68 %) and was associated with a significantly increased baseline risk profile (advanced age, higher body mass index, higher incidence of diabetes, hypercholesterolemia, previous angioplasty and multivessel disease, p < 0.001 for all). MACE were more frequent in patients with hypertension as compared to patients without hypertension (45 [8 %] vs. 8 [3 %], p < 0.01). Antecedent hypertension remained an independent predictor of MACE after multivariate adjustment (hazard ratio 3.42 [confidence interval 1.45-8.08], p < 0.01). There was, however, no significant difference in the area at risk, infarct size, myocardial salvage index, extent of microvascular obstruction, and left ventricular ejection fraction between the groups (all p > 0.05).
Despite a higher rate of MACE in contemporary reperfused STEMI patients with antecedent hypertension, there was no difference in reperfusion efficacy, infarct size and reperfusion injury as visualized by CMR.
NCT00712101 .
既往高血压与ST段抬高型心肌梗死（STEMI）患者的不良预后相关。心肌挽救、梗死面积和微血管损伤的差异是否导致不良预后尚不清楚。我们在AIDA-STEMI试验（阿昔单抗冠状动脉内给药与静脉给药治疗ST段抬高型心肌梗死）的多中心心脏磁共振（CMR）子研究中，调查了既往高血压与心肌挽救和损伤的CMR参数之间的关联。
我们分析了792例症状发作后12小时内接受再灌注治疗的连续STEMI患者。患者在心肌梗死后10天内接受CMR成像，以评估心肌挽救、梗死面积和微血管阻塞情况。在12个月的随访中记录主要不良心脏事件（MACE）。
540例患者（68%）存在既往高血压，且与基线风险特征显著增加相关（年龄较大、体重指数较高、糖尿病、高胆固醇血症、既往血管成形术和多支血管病变的发生率较高，所有p<0.001）。与无高血压患者相比，高血压患者的MACE更常见（45例[8%]对8例[3%]，p<0.01）。多变量调整后，既往高血压仍然是MACE的独立预测因素（风险比3.42[置信区间1.45-8.08]，p<0.01）。然而，两组之间的危险区面积、梗死面积、心肌挽救指数、微血管阻塞程度和左心室射血分数没有显著差异（所有p>0.05）。
尽管当代接受再灌注治疗的既往高血压STEMI患者的MACE发生率较高，但CMR显示的再灌注疗效、梗死面积和再灌注损伤并无差异。
NCT00712101
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