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

作者：Pengyu Zhou, Fen Sa, Kaisaierjiang Aisikaier, Yi-Xiang Wang, Zhixiang Dong, Xuan Ma, Yun Tang, Zhuxin Wei, Xi Jia, X Y Chen, Y H Liu, Wenqing Xu, Shujuan Yang, F. Zhao, Kankan Zhao, Minjie Lu, Xiuyu Chen, Shihua Zhao · 发表于：JACC Asia · 年份：2026 · DOI：10.1016/j.jacasi.2026.06.014 · 研究领域：Cardiac Imaging and Diagnostics、Acute Myocardial Infarction Research、Advanced MRI Techniques and Applications

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 re...