Prediction of adverse left ventricular remodeling by culprit lesion features in patients with LAD-related myocardial infarction

High-quality evidence regarding the associations between culprit lesion features and cardiac function after post-percutaneous coronary intervention (PCI) in ST-segment elevation acute myocardial infarction (STEMI) patients is still needed. Cardiac magnetic resonance (CMR) can be used to visually and quantitatively evaluate myocardial damage. The purpose of this study was to validate the ability of culprit lesion features to predict adverse left ventricular (LV) remodeling evaluated by CMR imaging in left anterior descending artery (LAD)-related STEMI. Eighty-two STEMI patients treated with primary PCI were included. LAD culprit lesion location (CLL) and preprocedural thrombolysis in myocardial infarction (TIMI) flow were obtained from coronary arteriography. All the subjects underwent acute and 4-month follow-up CMR examinations. CMR cine and late gadolinium enhancement (LGE) images were analyzed to evaluate LV function and myocardial infarct (MI) scar characteristics. The correlations between angiographic and CMR characteristics, and the predictive values of culprit lesion features for adverse LV remodeling calculated by CMR were evaluated. LAD-CLL was negatively correlated with infarct size (r = -0.41, p < 0.05). Compared with patients with microvascular obstruction (MVO) and transmural MI, LAD-CLL was statistically significantly longer in MVO absent (30.8 ± 9.6 mm vs. 25.6 ± 7.5 mm, p = 0.008) and non-transmural MI (30.6 ± 8.4 mm vs. 25.0 ± 7.8 mm, p = 0.001). Logistic regression analysis demonstrated that LAD-CLL [odds ratio (OR) = 0.837 (0.754-0.929), p = 0.001] and BMI [OR = 1.286 (1.065-1.554), p = 0.009) were independent predictors of adverse LV remodeling. Proximal-LAD culprit lesions were associated with severe myocardial injury, as evaluated by CMR. The LAD-CLL is a promising parameter for predicting adverse LV remodeling after MI.