Prognosis after ST-elevation myocardial infarction: a study on cardiac magnetic resonance imaging versus clinical routine.

Publisher: BioMed Central Country of Publication: England NLM ID: 101263253 Publication Model: Electronic Cited Medium: Internet ISSN: 1745-6215 (Electronic) Linking ISSN: 17456215 NLM ISO Abbreviation: Trials Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2006-

Magnetic Resonance Imaging* ; Percutaneous Coronary Intervention*/adverse effects ; Percutaneous Coronary Intervention*/mortality ; Stroke Volume* ; Ventricular Function, Left*; Myocardial Infarction/*therapy ; Myocardium/*pathology; Aged ; Chi-Square Distribution ; Clinical Trials as Topic ; Contrast Media ; Coronary Circulation ; Female ; Germany ; Heart Failure/etiology ; Humans ; Male ; Microcirculation ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/mortality ; Myocardial Infarction/pathology ; Myocardial Infarction/physiopathology ; Organometallic Compounds ; Predictive Value of Tests ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

Background: This study aimed to evaluate the incremental prognostic value of infarct size, microvascular obstruction (MO), myocardial salvage index (MSI), and left ventricular ejection fraction (LV-EFCMR) assessed by cardiac magnetic resonance imaging (CMR) in comparison to traditional outcome markers in patients with ST-elevation myocardial infarction (STEMI) reperfused by primary percutaneous intervention (PCI).
Methods: STEMI patients reperfused by primary PCI (n=278) within 12 hours after symptom onset underwent CMR three days after the index event (interquartile range [IQR] two to four). Infarct size and MO were measured 15 minutes after gadolinium injection. T2-weighted and contrast-enhanced CMR were used to calculate MSI. In addition, traditional outcome markers such as ST-segment resolution, pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI)-flow, maximum level of creatine kinase-MB, TIMI-risk score, and left ventricular ejection fraction assessed by echocardiography were determined in all patients. Clinical follow-up was conducted after 19 months (IQR 10 to 27). The primary endpoint was defined as a composite of death, myocardial reinfarction, and congestive heart failure (MACE).
Results: In multivariable Cox regression analysis, adjusting for all traditional outcome parameters significantly associated with the primary endpoint in univariable analysis, MSI was identified as an independent predictor for the occurrence of MACE (Hazard ratio 0.94, 95% CI 0.92 to 0.96, P<0.001). Further, C-statistics comparing a model including only traditional outcome markers to a model including CMR parameters on top of traditional outcome markers revealed an incremental prognostic value of CMR parameters (0.74 versus 0.94, P<0.001).
Conclusions: CMR parameters such as infarct size, MO, MSI, and LV-EFCMR add incremental prognostic value above traditional outcome markers alone in acute reperfused STEMI.
Trial Registration: Clinicaltrials.gov NCT00463749, Clinicaltrials.gov NCT00359918.

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ClinicalTrials.gov NCT00359918; NCT00463749

0 (Contrast Media)
0 (Organometallic Compounds)
1BJ477IO2L (gadobutrol)

Date Created: 20140626 Date Completed: 20150331 Latest Revision: 20211021

20221213

PMC4083878

10.1186/1745-6215-15-249

24962156