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Background <p>Despite the success of primary percutaneous coronary intervention (PPCI) in restoring epicardial coronary arteries blood flow post-acute ST-elevation myocardial infarction (STEMI), insufficient myocardial perfusion noted. Coronary microvascular injury (CMI) emerges as the most possible explanation that exhibits a distinct predictor of the resultant adverse cardiovascular consequences. Timely detection and evaluation of CMI play a crucial role in enhancing patient prognosis. Nonetheless, the availability of practical and cost-efficient diagnostic methodologies remains constrained within clinical settings.</p> Purpose <p>To assess the ability of Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT-MPI) in CMI detection and prediction after successful PPCI and to evaluate the impact of underlying identified myocardial perfusion abnormalities in the clinical outcome over six months period.</p> Methods <p>The study was a prospective cohort analysis of 150 patients with acute single-vessel STEMI status post successful PPCI. SPECT-MPI performed to assess culprit coronary artery-related myocardial perfusion pattern and to rule out residual ischemia. Patients with normal perfusion patterns labelled as group I while those with reversed perfusion defects and confirmed patent well-functioning stents considered having CMI and labelled as group II. Different clinical, echocardiographic, angiographic, SPECT variables and clinical outcomes were examined. Multivariate analysis identified independent CMI predictors.</p> Results <p>CMI was detected in 24% of the study population. Anterior STEMI, left anterior descending artery occlusion, prolonged door-to-balloon time, increased left ventricular volumes and reduced ejection fraction were identified as independent CMI predictors. CMI patients had significantly higher ischemic burden and heart failure hospitalizations at six-month follow-up.</p> Conclusion <p>SPECT-MPI is a practical non-invasive cost-effective screening modality for early detection of CMI following successful PPCI. The identified clinical and imaging predictors allow early detection, risk stratification and provide a basis for targeted interventions and management strategies to reduce CMI-related complications.</p> Trial registration <p>ZU-IRB#10990-13-8-2023, Registered 13/08/2023, email: IRB_123@medicine.zu.edu.eg.</p>

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Coronary microvascular injury detection and prediction after successful primary percutaneous coronary intervention: non-invasive assessment using single photon emission tomography myocardial perfusion imaging

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Ragab Abdulsalam Mahfouz,
  • Mohammad Gouda Mohammad,
  • Shady G. Ouf,
  • Azza Seddiq Ahmad Zidan,
  • Mohamed Mesbah Taha

摘要

Background

Despite the success of primary percutaneous coronary intervention (PPCI) in restoring epicardial coronary arteries blood flow post-acute ST-elevation myocardial infarction (STEMI), insufficient myocardial perfusion noted. Coronary microvascular injury (CMI) emerges as the most possible explanation that exhibits a distinct predictor of the resultant adverse cardiovascular consequences. Timely detection and evaluation of CMI play a crucial role in enhancing patient prognosis. Nonetheless, the availability of practical and cost-efficient diagnostic methodologies remains constrained within clinical settings.

Purpose

To assess the ability of Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT-MPI) in CMI detection and prediction after successful PPCI and to evaluate the impact of underlying identified myocardial perfusion abnormalities in the clinical outcome over six months period.

Methods

The study was a prospective cohort analysis of 150 patients with acute single-vessel STEMI status post successful PPCI. SPECT-MPI performed to assess culprit coronary artery-related myocardial perfusion pattern and to rule out residual ischemia. Patients with normal perfusion patterns labelled as group I while those with reversed perfusion defects and confirmed patent well-functioning stents considered having CMI and labelled as group II. Different clinical, echocardiographic, angiographic, SPECT variables and clinical outcomes were examined. Multivariate analysis identified independent CMI predictors.

Results

CMI was detected in 24% of the study population. Anterior STEMI, left anterior descending artery occlusion, prolonged door-to-balloon time, increased left ventricular volumes and reduced ejection fraction were identified as independent CMI predictors. CMI patients had significantly higher ischemic burden and heart failure hospitalizations at six-month follow-up.

Conclusion

SPECT-MPI is a practical non-invasive cost-effective screening modality for early detection of CMI following successful PPCI. The identified clinical and imaging predictors allow early detection, risk stratification and provide a basis for targeted interventions and management strategies to reduce CMI-related complications.

Trial registration

ZU-IRB#10990-13-8-2023, Registered 13/08/2023, email: IRB_123@medicine.zu.edu.eg.