Intramyocardial Hemorrhage Leads to Higher MACE Rate by Increasing Myocardial Infarction Volume in Patients with STEMI

Figures & data

Table 1 Clinical Features of Patients According to IMH

	IMH Absent (n=38)	IMH Present (n=27)	P-value
Age, years	58.3±11.4	57.1±9.3	0.497
Male, n (%)	33 (86.8%)	20 (74.1%)	0.191
Day CMR after MI, days	5.5±2.3	5.4±3.1	0.446
SBP, mmHg	118.3±19.1	116.5±21.2	0.665
DBP, mmHg	71.6±11.5	74.4±15.6	0.571
Pulse, Times/min	81.1±15.3	79.1±14.2	0.562
Comorbidities, n (%)
Smoking	25 (65.8%)	20 (74.1%)	0.476
T2DM	10 (26.3%)	7 (25.9%)	0.792
Hypertension	16 (42.1%)	14 (51.9%)	0.473
Hyperlipidaemia	7 (18.4%)	4 (14.8%)	0.702
Stroke	2(5.3%)	0(0%)	0.507
COPD	3(7.9%)	1(3.7%)	0.636
Medications, n (%)
Aspirin	37 (97.4%)	25 (92.6%)	0.565
Clopidogrel	26 (68.4%)	14 (51.9%)	0.176
Tigrilol	8 (21.1%)	9 (33.3%)	0.267
Tirofiban	5 (13.2%)	3 (11.1%)	0.855
LMWH	17 (44.7%)	9 (33.3%)	0.355
Infarct related artery, n (%)
Left anterior descending	17 (44.7%)	19 (70.4%)	0.040
Left circumflex	9 (23.7%)	6 (22.2%)	0.890
Right coronary artery	11 (29.0%)	2 (7.4%)	0.233
Left main	1 (2.6%)	0 (0%)	0.396
Killip-class on admission, n (%)			0.357
I	5 (13.2%)	7 (25.9%)
II	12 (31.6%)	11 (40.7%)
III	13 (34.1%)	6 (22.2%)
IV	8 (21.1%)	3 (11.1%)

Notes: Data are (N) Mean (SD) or (N) n (%), Median (Q3-Q1), where N is the total number of patients with available data. Boldface indicates statistical significance (P < 0.05).

Abbreviations: COPD, chronic obstructive pulmonary disease; DBP, diastolic blood pressure; CMR, cardiac magnetic resonance; DBP, Diastolic blood pressure; SBP, systolic blood pressure; LMWH, low molecular weight heparin; T2DM, type 2 diabetes mellitus.

Table 2 Laboratory Examination and Cardiac Parameters According to IMH

	IMH Absent (n=38)	IMH Present (n=27)	P-value
HGB, g/L	130.6±20.2	130.7±19.3	0.986
WBC, 10^9/L	9.4±4.0	9.6±4.1	0.814
PLT, 10^9/L	218.0±94.2	230.5±71.0	0.563
TC, mmol/L	1.5±0.9	1.6±0.8	0.708
TG, mmol/L	3.2±0.5	4.1±0.9	0.424
LDL-C, mmol/L	2.4±0.7	2.6±0.8	0.273
CRP, mg/L	29.4±32.9	81.9±68.5	0.010
CK-MB, u/L	52.7 (25.8–303.0)	161.6 (55.5–540.5)	0.011
HsTnT, pg/mL	1710.0 (203.0–3363.5)	2500.0 (1681.5–4307.0)	0.021
NT-proBNP, pg/mL	1618.0 (863.5–3066.8)	1901.0 (750.0–3233.5)	0.821
ECG findings, n (%)
PR interval, ms	161.4±30.1	153.0±17.3	0.229
Corrected QT interval, ms	456.1±45.3	449.4±41.5	0.554
QRS duration, ms	118.8±143.7	91.3±20.2	0.348
Q wave	20 (52.6%)	17 (63.0%)	0.407
Echocardiographic findings
LAESd, mm	38.1±5.7	37.5±4.3	0.310
RAESd, mm	33.4±4.3	32.1±4.1	0.446
LVEDd, mm	56.7±9.9	53.9±7.1	0.434
RVEDd, mm	32.1±3.7	31.6±5.5	0.329
LVEF, (%)	46.8±12.2	41.3±11.1	0.065
CMR findings, n (%)
MVO	14 (36.8%)	23 (85.2%)	<0.001
Ventricular aneurysm	12 (41.4%)	11 (44.0%)	0.846
Infarction volume, cm^3	21.1 ± 13.1	34.2±12.7	<0.001
IMH volume, cm^3	-	5.6±4.1	-
Cardiac output, L/min	5.3±2.1	4.9±2.6	0.110
LVEF (CMR), (%)	42.3±11.0	30.7±9.8	<0.001

Notes: Data are (N) Mean (SD) or (N) n (%), Median (Q3-Q1), where N is the total number of patients with available data. Boldface indicates statistical significance (P < 0.05).

Abbreviations: CRP, C-reactive protein; CK-MB, creatine kinase-MB; TC, total Cholesterol; TG, Triglyceride; LDL-C, low density lipoprotein-cholesterol; LAESd, Left Atrium End Systolic diameter; LVEDd, Left Ventricular End Diastolic diameter; RAESd, Right Atrium End Systolic diameter; RVEDd, Right Ventricular End Diastolic diameter; LVEF, Left Ventricular Ejection Fraction; IMH, intramyocardial hemorrhage; MVO, microvascular obstruction.

Figure 1 Kaplan–Meier curve showing the risk of MACE according to the presence or absence of IMH.

Table 3 Patient Characteristics According to Major Adverse Cardiac Events

	MACE-Absent (N=49)	MACE-Present (N=16)	P-value
Age, years	58.3(11.1)	56.3(8.6)	0.510
Male, n (%)	43 (87.8%)	10(62.5%)	0.057
SBP, mmHg	118±20	117±19	0.520
DBP, mmHg	72±13	74±14	0.410
Pulse, times/min	80 (68, 89)	86 (71, 96)	0.332
TC, mmol/L	3.84 (3.56, 4.56)	3.92 (3.41, 4.41)	0.845
TG, mmol/L	1.37 (1.00, 1.84)	1.25 (1.03, 1.58)	0.815
LDL-C, mmol/L	2.35 (2.08, 3.02)	2.29 (2.00, 2.99)	0.910
CK-MB, u/L	56 (24, 216)	342 (112, 624)	0.005
HsTnT, pg/mL	1710 (215, 3070)	3600 (2489, 6551)	<0.001
NT-proBNP, pg/mL	1287 (809, 2796)	2683 (1169, 3698)	0.110
Echocardiographic findings
LAESd, mm	37.9±5.5	37.6±3.9	0.857
RAESd, mm	55.2±9.5	56.5±7.0	0.613
LVEDd, mm	33.1±4.5	31.9±3.0	0.332
RVEDd, mm	32.3±4.7	30.4±3.4	0.144
LVEF, (%)	46.3±11.9	39.1±10.7	0.035
CMR findings, n (%)
MVO	24 (49%)	14 (87.5%)	0.007
Ventricular aneurysm	14 (36.8%)	9 (56.2%)	0.188
IMH	15 (30.6%)	12 (75%)	0.002
Infarction volume, cm^3	24.2±13.4	33.7±15.3	0.020
Cardiac output, L/min	5.5±2.5	4.4±1.1	0.114
LVEF (CMR), (%)	40.4±11.4	28.7±8.8	0.002
Infarct related artery, n (%)
Left anterior descending	25(51.0%)	11(68.8%)	0.215
Left circumflex	13(26.5%)	3 (18.8%)	0.744
Right coronary artery	10(20.4%)	2 (12.5%)	0.756
Left main	1(2.01%)	0 (0%)	0.490
Killip-class on admission, n (%)			0.523
I	10 (20.4%)	2 (12.5%)
II	18 (36.7%)	5 (31.2%)
III	12 (24.5%)	7 (43.8%)
IV	9 (18.4%)	2 (12.5%)

Notes: Data are (N) Mean (SD) or (N) n (%), Median (Q3-Q1), where N is the total number of patients with available data. Boldface indicates statistical significance (P < 0.05).

Table 4 Univariate and Multivariate Cox Hazard Analyses of Predictors for MACE

Variables	Univariate			Multivariate
	HR	95% CI	p value	HR	95% CI	p value
Age	0.980	0.930–1.020	0.366	–	–	–
Male	1.540	0.530–4.510	0.431	–	–	–
SBP	1.005	0.975–1.026	0.968	–	–	–
Killip-class	1.112	0.788–1.226	0.834	–	–	–
Hypertension	0.690	0.250–5.491	0.183	–	–	–
Diabetes	1.521	0.247–1.978	0.428	–	–	–
Smoking	1.796	1.186–2.721	0.490	–	–	–
LAD infarction	1.090	0.360–3.270	0.882	–	–	–
MVO present	4.080	1.010–18.26	0.032	3.940	1.000–10.250	0.049
Ventricular aneurysm	1.480	0.540–4.100	0.444	–	–	–
IMH present	3.240	1.03–10.210	0.031	3.151	1.000–9.931	0.039
Cardiac output	0.77	0.51–1.150	0.143	–	–	–

Note: Boldface indicates statistical significance (P < 0.05).

Abbreviations: HR, Hazard ratio; CI, Confidence interval; LAD, Left anterior descending; SBP, systolic blood pressure; LAD, Left anterior descending; IMH, intramyocardial hemorrhage; MVO, microvascular obstruction.

Figure 2 (a) The IMH group had a significantly higher MI volume than the IMH-absent group; (b) The MVO group had a significantly higher MI volume than the MVO-absent group; (c) HsTnT results during hospitalization of two groups of patients; (d) Relationship between IMH volume and MI volume. (***p<0.001; *p<0.05).

Figure 3 (a) LVEF of IMH-present group was lower than IMH-absent group; (b) It was no significant difference between MVO-present and MVO-absent group; (c) LVEF of MACE-present group was lower than MACE-absent group. (***p<0.001, **p<0.01).

Abbreviation: ns, not significant.