[The predictive value of microvascular obstruction for adverse left ventricular remodeling after primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a prospective study].

Objectives: Microvascular obstruction (MVO) is a specific cardiac magnetic resonance (CMR) imaging feature in patients with acute myocardial infarction. The purpose of this study was to elucidate the predictive value of MVO in left ventricular adverse remodeling after primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 167 patients with STEMI undergoing primary PCI in the Chinese PLA General Hospital from 2016 to 2020 were enrolled in this prospective cohort study, the average age of study patients was 57±10 years old, with 151 males (90.4%) and 16 females (9.6%). The patients were divided into the MVO group (n=81) and non-MVO group (n=86) according to the presence or absence of MVO on CMR imaging, respectively. The primary endpoint of the study was the occurrence of left ventricular adverse remodeling, which was defined as an increase in left ventricular end diastolic volume (LVEDV) by >20% at 6 months after primary PCI compared with the baseline. Patients who completed follow-up were diagnosed as left ventricular adverse remodeling or no left ventricular adverse remodeling according to CMR. The baseline data, perioperative data, and related data of end points were compared between the MVO group and non-MVO group. Finally, the predictive value of MVO in left ventricular adverse remodeling was calculated by receiver operating characteristic curve analysis. Results: In the baseline data, preoperative thrombolysis in myocardial infarction (TIMI) flow (χ2=13.74, P=0.003) and postoperative TIMI flow (χ2=14.87, P=0.001) were both obviously decreased in the MVO group. After 6 months of follow-up, the incidence of left ventricular adverse remodeling in the MVO group was significantly higher than that in the non-MVO group [37.0%(27/73) vs. 18.9%(14/74), χ2=5.96, P=0.015]. The left ventricular end systolic volume at 6 months post infarction in the MVO group was significantly larger than that in the non-MVO group [(94±32) vs. (68±20) ml, t=-5.98, P<0.001], as well as the LVEDV [(169±38) vs. (143±29) ml, t=-4.74, P<0.001]. Receiver operating characteristic curve showed that the area under the curve of MVO size for predicting left ventricular adverse remodeling was 0.637. Conclusion: The risk of left ventricular adverse remodeling is significantly increased in patients with MVO after primary PCI for acute STEMI.目的： 进一步明确微循环阻塞现象（MVO）对于急性ST段抬高型心肌梗死（STEMI）患者直接经皮冠脉介入（PCI）术后左心室恶化重构的预测价值。 方法： 前瞻性队列研究。前瞻性纳入2016年至2020年解放军总医院进行直接PCI术的STEMI患者，共167例患者纳入研究，平均年龄（57±10）岁，男性151例（90.4%），女性16例（9.6%）。根据术后1周内心脏磁共振（CMR）结果是否存在MVO征象将患者分为MVO组（n=81）和无MVO组（n=86）。主要研究终点为左心室恶化重构的发生：定义为术后6个月CMR检查发现左室舒张末容积（LVEDV）较基线术后1周内的LVEDV增大超过20%。将完成随访的心肌梗死患者分为左心室恶化重构和无左心室恶化重构。比较MVO组与无MVO组的基线资料、围术期数据及主要终点的相关数据，最后通过受试者工作特征（ROC）曲线计算MVO对左室重构的预测价值。 结果： 在基线资料中，MVO组患者的术前心梗溶栓（TIMI）血流分级（χ2=13.74，P=0.003）和术后TIMI血流分级（χ2=14.87，P=0.001）均明显低于无MVO组。经过6个月的随访观察，MVO组左室恶化重构的发生率明显高于无MVO组［37.0%（27/73）比18.9%（14/74），χ2=5.96，P=0.015］、同时相对应的MVO组6个月后的左室收缩末容积明显高于无MVO组［（94±32）比（68±20）ml，t=-5.98，P<0.001］、6个月后的LVEDV明显高于无MVO组［（169±38）比（143±29）ml，t=-4.74，P<0.001］。ROC曲线结果显示MVO面积对于预测左心室重构的曲线下面积为0.637。 结论： STEMI患者直接PCI术后出现MVO征象的患者发生左心室恶化重构的风险明显增加。.