Long-term prognostic value of microvascular obstruction by cardiac magnetic resonance in ST-segment elevation myocardial infarction

Raquel P Amier, Casper W H Beijnink, José F Rodriguez Palomares, Martijn W Smulders, Gonzalo Pizarro Sánchez, Rodrigo Fernández-Jiménez, Filipa X Valente, Albert C van Rossum, Niels van Royen, Borja Ibañez and Robin Nijveldt

PLOS ONE, 2026, vol. 21, issue 3, 1-10

Abstract: Aims: Microvascular obstruction (MVO) portends a higher risk of remodelling and adverse events following ST-segment elevation myocardial infarction (STEMI). However, data regarding the implications of MVO in STEMI beyond five years of follow-up are scarce. Methods & Results: This is a pooled analysis of three observational studies including 876 prospectively enrolled reperfused first STEMI patients, who underwent cardiac magnetic resonance imaging with late gadolinium enhancement (LGE), between 2003–2019. Median follow-up duration was 6.3 (IQR 3.6–9.3) years. The primary outcome was all-cause mortality. The secondary outcome was a combined endpoint of all-cause mortality and recurrent ischemic events (i.e., myocardial infarction or stroke). We performed Cox regression analyses with a time-dependent covariate. Conclusions: In STEMI patients, the presence of MVO by cardiac magnetic resonance imaging is associated with a more than two-fold higher risk of all-cause mortality up to six years after the index event. This relation seems to dissipate beyond this time period.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0344442

DOI: 10.1371/journal.pone.0344442

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