Temporal Trends in Infarct Severity Outcomes in ST-Segment-Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study.
Ivan LechnerMartin ReindlChristina TillerMagdalena HolzknechtPriscilla FinkFelix TrogerGeorg AngererSimon AngererBenjamin HenningerAgnes MayrGert KlugAxel BauerBernhard MetzlerSebastian Johannes ReinstadlerPublished in: Journal of the American Heart Association (2023)
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 ( P =0.25), microvascular obstruction ( P =0.50), and intramyocardial hemorrhage ( P =0.34). Left ventricular remodeling indices and left ventricular ejection fraction remained virtually unchanged (all P >0.05). Major adverse cardiovascular events at 4 (interquartile range, 4-5) months were similar between groups ( P =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.
Keyphrases
- percutaneous coronary intervention
- st segment elevation myocardial infarction
- left ventricular
- acute myocardial infarction
- magnetic resonance imaging
- st elevation myocardial infarction
- coronary artery disease
- acute coronary syndrome
- antiplatelet therapy
- cardiovascular events
- coronary artery bypass grafting
- heart failure
- randomized controlled trial
- emergency department
- hypertrophic cardiomyopathy
- type diabetes
- cardiovascular disease
- clinical trial
- oxidative stress
- atrial fibrillation
- cardiac resynchronization therapy
- left atrial
- adipose tissue