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This observational study aimed to clarify by Cardiac Magnetic Imaging (CMR) whether indicated culprit vessel results in different cardiac impairment in STEMI patients in the ear of reperfusion therapy.
Among 231 reperfused first-time ST-elevation myocardial infarction (STEMI) patients, 133 had culprit left anterior descending artery (LAD) and 98 had non-LAD culprit vessels. All patients received comprehensive CMR examination within 1 week after symptom onset.
The two groups had similar reperfusion time and achieved comparable epicardial/microvascular flow recovery. However, patients with culprit LAD showed more severe pump dysfunction than others (LVEF, 49.0 ± 12.1% vs. 55.6 ± 9.0%, p<0.001). Possible explanations include; more myocardial necrosis (27.8 ± 13.9% vs. 19.8 ± 9.6% of left ventricle myocardial mass, p<0.001), more segments involvement (6.06 ± 2.91 vs. 4.4 ± 2.10 segments, P<0.001) and higher rates of apical rotation impairment (53.4% vs.30.6%, p<0.001) related to culprit LAD. Besides, infarction of LAD-dominant segments seemed more correlated to global LVEF reduction.
On a general perspective, culprit LAD may cause more severe injury and cardiac dysfunction than other coronary vessels do. It may be regarded as a straight clinical indicator of higher risks.