Impact of blood pressure on the extent of microvascular damage in the setting of reperfusion injury in STEMI asessed with magnetic resonance imaging

Abstract Hypertension is a poor prognostic factor following STEMI, however the impact of blood pressure (BP) on the extent of microvascular damage in the setting of acute ischemia -reperfusion injury has not yet been fully evaluated and this evaluation is the purpose of the present study. Methods A cohort of patients with acute STEMI referred to primary percutaneus intervention were prospectively included. Angiographic analysis were performed according to standard clinical practice and decision regarding type of stent and antiplatelet drugs was left to the discretion of cardiologist. Information about high blood pressure needing drug therapy before acute event and also BP levels at catheterization laboratory during reperfusion procedures were assessed. All patients underwent cardiac MRI during the first week post reperfusion with a standardized protocol including 8–10 short axis slices in order to asses: area of myocardium at risk (AR) as an area of signal hyperintensity >2sd with respect to the remote one in TSE-T2 sequences, necrosis size (NS) as signal hyperintensity >5 SDs relative to the remote in IR-FGE sequences, microvascular obstruction (MVO) as signal hypointensity in the infarct core in IR-FGE sequences and intra-infarct haemorrhage (IIH) as an area with T2*