Abstract 15320: MVO Detected by Contrast Enhanced CMR as a Predictor of MACE in Patients With Acute MI. A Meta-Analysis of Prospective Trials
Background: Microvascular obstruction (MVO) after reperfusion therapy for Acute MI, also known as ‘no reflow’ phenomenon reflects significant microvessel injury and has been implicated as a prognostic marker for occurrence of major adverse cardiac events (MACE). Contrast Enhanced CMR (CE-CMR) is the leading diagnostic modality to access the presence and extent of MVO.
Objective: To determine the predictive value of MVO, as evidenced by CE-CMR, as a predictor of MACE in patients with Acute myocardial infarction.
Methods: A systemic review of Medline, Cochrane, and Embase for all the clinical trials using CMR to detect MVO and assessing its association MACE was performed. Given the high heterogeneity (i.e. I2 > 25), we used a random effect model.
Results: A total of 8 studies with 1708 patients (male: 79%, mean age 60years (SD=+/-3) fulfilled the inclusion criteria. The overall incidence for MVO was 7% (SD= +/- 7). 818 patients were found to have MVO on CE-CMR out of which 17% (216) had MACE on follow up. 890 patients did not have MVO on CE-MRI out of which 8% (73) had MACE. The Odds ratio (OR) for MACE in the presence of MVO (OR 3.68, 95%CI 2-3), which showed that the presence of MVO on CE-CMR increases the chance of developing MACE by 3.7 folds. Moreover, the mean sensitivity and specificity were 71% and 61%, whereas PPV and NPV were 31% and 89% respectively.
Conclusion: MVO detected by CE-CMR is a strong predictor for MACE and moreover it had an excellent NPV so it can be used as an screening tool.
- © 2013 by American Heart Association, Inc.