Impact of Persistent Microvascular Obstruction Late After STEMI on Adverse LV Remodeling: A CMR Study.

BACKGROUND: Little is known about the occurrence and implications of persistent microvascular obstruction (MVO) after reperfused ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: The authors used cardiac magnetic resonance (CMR) to characterize the impact of persistent MVO on adverse left ventricular remodeling (ALVR). METHODS: A prospective registry of 471 STEMI patients underwent CMR 7 (IQR: 5-10) days and 198 (IQR: 167-231) days after infarction. MVO (≥1 segment) and ALVR (relative increase >15% at follow-up CMR) of left ventricular end-diastolic index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were determined. RESULTS: One-week MVO occurred in 209 patients (44%) and persisted in 30 (6%). The extent of MVO (P = 0.026) and intramyocardial hemorrhage (P = 0.001) at 1 week were independently associated with the magnitude of MVO at follow-up CMR. Compared with patients without MVO (n = 262, 56%) or with MVO only at 1 week (n = 179, 38%), those with persistent MVO at follow-up (n = 30, 6%) showed higher rates of ALVR-LVEDVI (22%, 27%, and 50%; P = 0.003) and ALVR-LVESVI (20%, 21%, and 53%; P < 0.001). After adjustment, persistent MVO at follow-up (≥1 segment) was independently associated with ΔLVEDVI (relative increase, %) (P < 0.001) and ΔLVESVI (P < 0.001). Compared with a 1:1 propensity score-matched population on CMR variables made up of 30 patients with MVO only at 1 week, patients with persistent MVO more frequently displayed ALVR-LVEDVI (12% vs 50%; P = 0.003) and ALVR-LVESVI (12% vs 53%; P = 0.001). CONCLUSIONS: MVO persists in a small percentage of patients in chronic phase after STEMI and exerts deleterious effects in terms of LV remodeling. These findings fuel the need for further research on microvascular injury repair.

Implementability of stroke guidelines: a pragmatic comparison between US and European recommendations using eGLIA.

Due to the prevalence and severity of stroke, and the emergency of its management, the need of reaching a consensus towards its treatment is of prime importance. This paper's aim is to compare two stroke guidelines by using eGLIA in order to evaluate their implementability. Methods included a systematic assessment of the European (ESO) and American (AHA/ASA) guidelines with eGLIA and a review of literature and analysis of each recommendation with the program. The ESO performs better in Executability and Decidability, as 91.5% and 34.8% of recommendations show no barriers, compared to 81.0% and 14.0% in the AHA/ASA guidelines. On the other hand, AHA/ASA guideline have more recommendations with positive assessments in the Validity and Effect on the Process of Care (91.4% vs 83.0% and 58.1% vs 25%). Results show that ESO guidelines address a wider patient view and that the AHA/ASA guidelines are stricter, only publishing recommendations with a high level of evidence; AHA/ASA guidelines are updated with more frequency and have a clearer sequence of action. Both guidelines show some contradictions, but of minor importance. The strength of this study is the fact that the whole guidelines were read and analysed, and, although we would suggest an improvement of the tool by adding an automatic statistics chart and clarifying some questions, it showed that eGLIA should be used whenever such a text is published.