Meta-Analysis of MACE in MI

SEE PAGES 930 AND 940 S ince the early days in research on myocardial infarction (MI), it has been recognized that MI size, whether determined by anatomic, electrocardiographic, enzymatic, or imaging methods, and post-MI adverse left ventricular (LV) remodeling are important determinants of early and late major myocardial adverse cardiac events (MACE). In studies of myocardial reperfusion, both in experimental models and in patients, the realization that reperfusion injury could exacerbate the effects of MI also came to the fore early on, and the role of microvascular obstruction (MO) consequent to reperfusion injury has been extensively recognized. The potential role of cardiac magnetic resonance (CMR) for depiction and evaluation of MI using gadolinium contrast became apparent as early as the late 1980s in work from Willerson’s group (1), although the potential relevance of CMR in coronary disease was really not appreciated until the contributions of Pohost and colleagues (2) on quantitation of ventricular size and function in the early 1990s. Work on the role of MO in MI in the late ’90s contributions of Wu, Lima, and Kim at Hopkins (3–5), followed by development of definitive methods for quantitation of MI size and transmural extent with CMR by Kim, Judd, and Simonetti (5) at Northwestern and Siemens, has made CMR the definitive technique for infarct sizing and detection of MO in vivo. More recently, CMR has provided means for pixel-level quantitation of myocardial perfusion and reliable detection of myocardial edema as a result of reversible injury in the noninfarcted portion of the risk region, so that the risk region and myocardial salvage by reperfusion can be