Work

Prognostic Value of Persistent Microvascular Obstruction on Follow-Up Cardiac MRI After Reperfused STEMI

Year: 2026

Type: article

Abstract: BACKGROUND: The prognostic value of persistent microvascular obstruction (persistent-MVO) in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI) remains unclear. OBJECTIVES: To investigate the prognostic value of persistent-MVO in reperfused STEMI. METHODS: Retrospectively analyzed 504 STEMI patients with primary PCI who underwent a follow-up cardiac magnetic resonance at ≥60 days after PCI. Persistent-MVO was defined as the presence of MVO on late gadolinium enhancement (LGE) imaging, which served as the study baseline. The endpoint was composite events of heart failure (HF), including HF-related death, heart transplantation, left ventricular assist device implantation, and HF hospitalization. Competing risk analysis was performed to address the possible influences of competing events. RESULTS: Persistent-MVO was detected in 44 of 504 patients (8.7%). These patients demonstrated lower left ventricular ejection fraction, larger end-diastolic volume index, and larger LGE extent (all P < 0.05), compared with those without. During a median follow-up of 64.5 months (IQR: 45.0-79.4), 91 of 504 patients (18.1%) experienced the endpoint. Adding persistent-MVO to a model with NYHA functional class, left ventricular ejection fraction, and LGE extent improved model discrimination (C-index: from 0.78 [95% CI: 0.73-0.83] to 0.82 [95% CI: 0.77-0.86], P = 0.01), model fit (-2 log-likelihood: from 996.7 to 984.8, P < 0.001), and risk reclassification (continuous net reclassification improvement: 8.56% [95% CI: 2.60%-16.23%], P < 0.01), with decision curve analysis confirming net clinical benefit at 5 years. CONCLUSIONS: Persistent-MVO was observed in 8.7% of STEMI patients at least 60 days after PCI and provided incremental value beyond established risk markers for predicting HF-related events.

Source: JACC Asia

DOI: 10.1016/j.jacasi.2026.06.014