CMR Detection Of Late Microvascular Obstruction And Intramyocardial Hemorrhage In Predicting MACE In AMI After Reperfusion Therapy :Meta-analysis

Background: Although the mortality of patients with acute myocardial infarction(AMI)after Percutaneous coronary intervention(PCI)or fibrinolytic therapy shows a decreasing trend,the number of patients with major adverse cardiovascular events(MACE)due to myocardial infarction is on the rise.Microvascular obstruction and intramyocardial hemorrhage are serious damage in AMI patients after reperfusion therapy and are associated with poor prognosis during follow-up.Cardiac magnetic resonance(CMR)is a useful non-invasive technique for determining whether patients with AMI have microvascular obstruction and intramyocardial hemorrhage after reperfusion therapy.Early detection of microvascular obstruction and intramyocardial hemorrhage is the first step in the development of targeted and individualized treatment.Delayed gadolinium enhancement can be used to detect early and late microvascular occlusion by regulating the scanning time after contrast agent injection.Compared with early microvascular obstruction,late microvascular obstruction is a stronger prognostic indicator of the MACE.To explore thepredictive value of late microvascular obstruction and intramyocardial hemorrhage detected by CMR for the MACE in patients with AMI after reperfusion therapy with Meta-analysis.Methods: A systematic search was conducted in databases of PubMed,Embase,Web of Science,CNKI,VIP and Wanfang.The literatures pubished before October 2018 were screened acording to the relationship between late microvascular obstruction and intramyocardial hemorrhage detected by CMR and the occurrence of MACE during follow-up in AMI after reperfusion therapy.The inclusion criteria were as follows:(1)Patients with AMI underwent CMR examination after PCI or fibrinolytic therapy;(2)controlled studies in which CMR detected the patients with late microvascular obstruction and without late microvascular obstruction whether occured the MACE during follow-up;(3)controlled studies in which CMR detected the patients with intramyocardial hemorrhage and without intramyocardial hemorrhage whether occured the MACE during follow-up;(4)MACE included cardiac death,recurrent myocardial infarction,cerebrovascular accident,persistent ventricular arrhythmia,target vessel revascularization,acute coronary syndrome,and heart failure.The Newcastle-Ottawa scale(NOS)was used to evaluate the quality of the included literatures,RevMan 5.3 and STATA 15.1 were used for statistical analysis of the data of the included literature,forest map and funnel map were made,and publication deviation was evaluated by Begg'stest and Egger's test.Results: A total of 11 articles were enrolled.Among them,9 articles on the relationship between late MVO and MACE with a total of 1872 patients,and 4 articles on the relationship between IMH and MACE with a total of 1017 patients.Odd ratio of late MVO detected by CMR predicting MACE occurrence was 4.04[95%CI(2.95,5.55),Z=8.65,P<0.001],Begg's test of funnel plot P=1.000,Egger's test P=0.714,without publication bias;Odd ratio of IMH detected by CMR predicting MACE occurrence was2.66[95%CI(1.78,3.96),Z=4.79,P < 0.001],Begg's test of funnel plot P=0.308,Egger's test P=0.132,without publication bias.Conclusion: The late microvascular obstruction and intramyocardial hemorrhage detected by CMR can be used to predict MACE during the follow-up in AMI after reperfusion therapy.