Cardiac sympathetic nerve activity in the non-culprit lesion predicts poor prognosis in patients with STEMI.
Takumi Kondo, Takahisa Yamada, Mitsutoshi Asai et al.
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In 30 seconds
This prospective study assessed whether regional cardiac sympathetic nerve activity (CSNA) adds prognostic information in 122 patients with STEMI. CSNA was measured using cardiac 123I-MIBG imaging, including global washout rate (WR) on planar images and regional WR in culprit and non-culprit lesions on SPECT. Over 4.2 ± 2.5 years, 34 patients experienced a major adverse cardiac event (MACE). Abnormal global WR and increased non-culprit lesion WR, but not culprit lesion WR, were independently associated with MACE after adjustment for clinical parameters and GRACE or TIMI risk scores; non-culprit findings added prognostic value to global WR.
Key findings
- During 4.2 ± 2.5 years of follow-up, 34 patients experienced MACE.
- Abnormal global WR and increased non-culprit lesion WR were independently associated with MACE; culprit lesion WR was not.
- Patients with both abnormal global WR and increased non-culprit lesion WR had higher MACE risk than those with either finding (p = 0.025) or neither (p < 0.001).
Why it matters
The findings suggest that sympathetic nerve activity in myocardium outside the culprit lesion may capture prognostic information not reflected by culprit-region assessment alone. Regional SPECT measures could therefore complement global CSNA and established clinical risk scores when characterising risk after STEMI, although the study establishes prognostic association rather than benefit from acting on the imaging result.
What to keep in mind
The study was prospective but observational, with 122 patients and 34 MACE events; it does not establish that imaging-guided management improves outcomes.