University Clinic of Internal Medicine III, Cardiology and Angiology Medical University of Innsbruck Innsbruck Austria.
University Clinic of Radiology Medical University of Innsbruck Innsbruck Austria.
J Am Heart Assoc. 2023 Aug;12(15):e028932. doi: 10.1161/JAHA.122.028932. Epub 2023 Jul 25.
Background Severity of myocardial tissue injury is a main determinant of morbidity and death related to ST-segment-elevation myocardial infarction (STEMI). Temporal trends of infarct characteristics at the myocardial tissue level have not been described. This study sought to assess temporal trends in infarct characteristics through a comprehensive assessment by cardiac magnetic resonance imaging at a standardized time point early after STEMI. Methods and Results We analyzed patients with STEMI treated with percutaneous coronary intervention at the University Hospital of Innsbruck who underwent cardiac magnetic resonance imaging between 2005 and 2021. The study period was divided into terciles. Myocardial damage characteristics were assessed using a multiparametric cardiac magnetic resonance imaging protocol within the first week after STEMI and compared between groups. A total of 843 patients with STEMI (17% women) with a median age of 57 (interquartile range, 51-66) years were analyzed. While age, sex, and the clinical risk profile expressed as thrombolysis in myocardial infarction risk score were comparable across the study period, there were differences in guideline-recommended therapies. At the same time, there was no significant change in infarct size (=0.25), microvascular obstruction (=0.50), and intramyocardial hemorrhage (=0.34). Left ventricular remodeling indices and left ventricular ejection fraction remained virtually unchanged (all >0.05). Major adverse cardiovascular events at 4 (interquartile range, 4-5) months were similar between groups (=0.36). Conclusions In this magnetic resonance imaging study investigating patients with STEMI treated with primary percutaneous coronary intervention over the past 15 years, no change in infarct severity at the myocardial level has been observed. Clinical research on novel therapeutic approaches to reduce myocardial tissue injury should be a priority.
心肌组织损伤的严重程度是与 ST 段抬高型心肌梗死（STEMI）相关发病率和死亡率的主要决定因素。心肌组织水平上梗死特征的时间趋势尚未描述。本研究旨在通过在 STEMI 后早期的标准化时间点进行心脏磁共振成像（CMR）综合评估来评估梗死特征的时间趋势。
我们分析了在因 STEMI 接受经皮冠状动脉介入治疗的因斯布鲁克大学医院接受 CMR 检查的患者。研究期间分为三分位数。在 STEMI 后第一周内使用多参数 CMR 成像方案评估心肌损伤特征，并在组间进行比较。共分析了 843 例 STEMI 患者（17%为女性），中位年龄为 57 岁（四分位距，51-66 岁）。虽然整个研究期间年龄、性别和以心肌梗死溶栓治疗风险评分表示的临床风险特征相似，但指南推荐的治疗方法存在差异。与此同时，梗死面积（=0.25）、微血管阻塞（=0.50）和心肌内出血（=0.34）没有显著变化。左心室重构指数和左心室射血分数几乎没有变化（均>0.05）。4 个月（四分位距，4-5 个月）时主要不良心血管事件在各组之间相似（=0.36）。
在这项对过去 15 年接受直接经皮冠状动脉介入治疗的 STEMI 患者进行的磁共振成像研究中，心肌水平的梗死严重程度没有变化。应优先开展针对减少心肌组织损伤的新型治疗方法的临床研究。
