Montone Rocco A, Niccoli Giampaolo, Minelli Silvia, Fracassi Francesco, Vetrugno Vincenzo, Aurigemma Cristina, Burzotta Francesco, Porto Italo, Trani Carlo, Crea Filippo
Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy; Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Int J Cardiol. 2017 Jun 1;236:30-35. doi: 10.1016/j.ijcard.2017.02.023. Epub 2017 Feb 12.
Microvascular obstruction (MVO) is associated with a worse prognosis in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). However, data about incidence, clinical outcome and correlates of MVO in latecomers after STEMI are still lacking.
We prospectively enrolled consecutive patients that were latecomers after STEMI (symptoms onset >12h) undergoing PCI. We performed an angiographic analysis to assess the occurrence of MVO [defined as TIMI flow grade ≤2 or 3 with a myocardial blush grade <2]. Moreover, we performed a clinical and echocardiographic follow-up to assess the occurrence of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, myocardial infarction and rehospitalization for heart failure, and to evaluate left ventricle remodelling.
Seventy-eight patients were enrolled [mean age 67.58±11.72years, 57 (73%) male; mean time of symptom onset 23.14±16.06h] with a mean follow-up time of 29.7±14.1months. MVO occurred in 39 (50%) patients. Patients with MVO had a higher rate of MACE [18 (46%) vs. 3 (8%), p<0.001] and LV remodelling [25 (64%) vs. 6 (15%), p<0.001] compared with patients without MVO. By multivariable Cox regression MVO and left anterior descending artery were independent predictors of MACE.
Latecomers after STEMI have a high risk to develop MVO that is related to an adverse prognosis. Appropriate management and follow-up strategies should be implemented in such high-risk patients group.
微血管阻塞（MVO）与接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者的预后较差相关。然而，关于STEMI后延迟就诊患者中MVO的发生率、临床结局及其相关因素的数据仍然缺乏。
我们前瞻性纳入了连续的STEMI后延迟就诊患者（症状发作>12小时），这些患者接受了PCI。我们进行了血管造影分析以评估MVO的发生情况[定义为心肌梗死溶栓试验（TIMI）血流分级≤2级或3级且心肌灌注分级<2级]。此外，我们进行了临床和超声心动图随访，以评估主要不良心血管事件（MACE）的发生情况，MACE定义为心源性死亡、心肌梗死和因心力衰竭再次住院的综合情况，并评估左心室重构。
共纳入78例患者[平均年龄67.58±11.72岁，57例（73%）为男性；症状发作的平均时间为23.14±16.06小时]，平均随访时间为29.7±14.1个月。39例（50%）患者发生了MVO。与未发生MVO的患者相比，发生MVO的患者MACE发生率更高[18例（46%）对3例（8%），p<0.001]，左心室重构发生率更高[25例（64%）对6例（15%），p<0.001]。通过多变量Cox回归分析，MVO和左前降支是MACE的独立预测因素。
STEMI后延迟就诊患者发生MVO的风险较高，这与不良预后相关。应在此类高危患者群体中实施适当的管理和随访策略。
