Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy -
Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy -
Minerva Cardiol Angiol. 2023 Aug;71(4):421-430. doi: 10.23736/S2724-5683.22.06156-7. Epub 2023 Feb 27.
Microvascular obstruction (MVO) is a frequent occurrence after primary percutaneous coronary intervention (pPCI), and is associated with adverse left ventricular remodeling and worse clinical outcome. Distal embolization of thrombotic material is one of the most important underlying mechanisms. The aim of this study was to investigate the relation between the thrombotic volume evaluated by dual quantitative coronary angiography (QCA) prior to stenting and the occurrence of MVO as assessed by cardiac magnetic resonance (CMR).
Forty-eight patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI and receiving CMR within 7 days from admission were included. Pre-stenting residual thrombus volume at the site of the culprit lesion was measured by applying automated edge detection and video-assisted densitometry techniques (i.e., dual-QCA), and patients were categorized into tertiles of thrombus volume. The presence of delayed-enhancement MVO, as well as its extent (MVO mass), were assessed by CMR.
Pre-stenting dual-QCA thrombus volume was significantly greater in patients with MVO than in those without (5.85 mm [2.05-16.71] vs. 1.88 mm [1.03-6.92], P=0.009). Patients in the highest tertile showed greater MVO mass compared to those in the mid and lowest tertiles (113.3 gr [0.0-203.8] vs. 58.5 g [0.00-144.4] vs. 0.0 g [0.0-60.225], respectively; P=0.031). The best cut-off value of dual-QCA thrombus volume for prediction of MVO was 2.07 mm (AUC: 0.720). The addition of dual-QCA thrombus volume to the traditional angiographic indices of no-reflow enhanced the prediction of MVO by CMR (R=0.752).
Pre-stenting dual-QCA thrombus volume is associated with the presence and extent of MVO detected by CMR in patients with STEMI. This methodology may aid the identification of patients at higher risk of MVO and guide adoption of preventive strategies.
微血管阻塞（MVO）是经皮冠状动脉介入治疗（pPCI）后的常见并发症，与左心室重构不良和临床预后恶化有关。血栓物质的远端栓塞是最重要的潜在机制之一。本研究旨在探讨支架置入术前双定量冠状动脉造影（QCA）评估的血栓体积与入院后 7 天内行心脏磁共振（CMR）评估的 MVO 发生之间的关系。
纳入 48 例接受 pPCI 并在入院后 7 天内行 CMR 的 ST 段抬高型心肌梗死（STEMI）患者。应用自动边缘检测和视频辅助密度测量技术（即双 QCA）测量罪犯病变部位支架置入术前残留血栓体积，并根据血栓体积分为三分位。通过 CMR 评估是否存在延迟增强型 MVO 及其范围（MVO 质量）。
MVO 患者支架置入术前双 QCA 血栓体积明显大于无 MVO 患者（5.85mm[2.05-16.71] vs. 1.88mm[1.03-6.92]，P=0.009）。最高三分位组患者的 MVO 质量大于中三分位组和低三分位组（113.3g[0.0-203.8] vs. 58.5g[0.00-144.4] vs. 0.0g[0.0-60.225]，P=0.031）。双 QCA 血栓体积预测 MVO 的最佳截断值为 2.07mm（AUC：0.720）。将双 QCA 血栓体积与无复流的传统血管造影指数相结合，可提高 CMR 预测 MVO 的效果（R=0.752）。
STEMI 患者支架置入术前双 QCA 血栓体积与 CMR 检测到的 MVO 存在和程度相关。该方法有助于识别 MVO 风险较高的患者，并指导采取预防策略。
