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. 2023 Aug;12(15):e028932.
doi: 10.1161/JAHA.122.028932. Epub 2023 Jul 25.

Temporal Trends in Infarct Severity Outcomes in ST-Segment-Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

Ivan Lechner  1 , Martin Reindl  1 , Christina Tiller  1 , Magdalena Holzknecht  1 , Priscilla Fink  1 , Felix Troger  2 , Georg Angerer  1 , Simon Angerer  1 , Benjamin Henninger  2 , Agnes Mayr  2 , Gert Klug  1 , Axel Bauer  1 , Bernhard Metzler  1 , Sebastian J Reinstadler  1
Affiliations

Temporal Trends in Infarct Severity Outcomes in ST-Segment-Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

Ivan Lechner et al. J Am Heart Assoc. 2023 Aug.

Abstract

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.

Keywords: ST‐segment–elevation myocardial infarction; cardiac magnetic resonance imaging; infarct size; prognosis; time trends.

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Figures

Figure 1
Figure 1. Key outcomes and insights from the study cohort.
ACEi indicates angiotensin‐converting‐enzyme inhibitor; ARNI, angiotensin receptor–neprilysin inhibitor; AT‐1, angiotensin II receptor type 1 antagonist; DES, drug‐eluting stent; DTB, door‐to‐balloon time; LVMM, left ventricular myocardial mass; MRA, mineralocorticoid receptor antagonist; MRI, magnetic resonance imaging; MVO, microvascular obstruction; pPCI, primary percutaneous coronary intervention; SGLT2i, sodium‐glucose cotransporter 2 inhibitor; and STEMI, ST‐segment–elevation myocardial infarction. Created with Biorender.
Figure 2
Figure 2. Change in microvascular injury with respect to study period.
IMH indicates intramyocardial hemorrhage; MVO, microvascular obstruction; n.a., not available.
Figure 3
Figure 3. Change in left ventricular ejection fraction with respect to study period.
LVEF indicates left ventricular ejection fraction.
Figure 4
Figure 4. Changes in outcome in relation to study period.
MACE indicates major adverse cardiac event; and STEMI, ST‐segment–elevation myocardial infarction.
See this image and copyright information in PMC

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