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Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic

Gianluca Pontone1, Andrea I Guaricci2, Daniele Andreini2

  • 1From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.). gianluca.pontone@ccfm.it.

Circulation. Cardiovascular Imaging
|November 18, 2017
PubMed

Insights

A new Cardiac Magnetic Resonance (CMR) score offers improved prognostic stratification for ST-segment-elevation myocardial infarction patients. This CMR score provides additional benefits over standard GRACE scores and LVEF measurements for predicting major adverse cardiac events.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Prognostics

Background:

  • ST-segment-elevation myocardial infarction (STEMI) management relies on risk stratification.
  • Cardiac Magnetic Resonance (CMR) assesses myocardial damage, but its prognostic value beyond standard methods needs clarification.

Purpose of the Study:

  • To evaluate the incremental prognostic benefit of a novel CMR score.
  • To compare the CMR score's performance against the Global Registry of Acute Coronary Events (GRACE) score and transthoracic echocardiography-derived left ventricular ejection fraction (LVEF).

Main Methods:

  • A cohort of 209 STEMI patients underwent CMR and echocardiography post-primary percutaneous coronary intervention.
  • A weighted CMR score was developed using CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage.
  • Major adverse cardiac events (MACE) were tracked over a mean follow-up of 2.5 years.

Main Results:

  • The CMR score independently predicted MACE (HR, 1.867 per SD increase; P<0.001).
  • Patients with MACE had higher GRACE scores, lower LVEF, lower myocardial salvage index, and more microvascular obstruction and hemorrhage.
  • The CMR score demonstrated the highest net reclassification improvement compared to GRACE score and echocardiography-LVEF.

Conclusions:

  • The developed CMR score offers superior prognostic stratification for STEMI patients.
  • This CMR score may significantly influence clinical decision-making and patient management strategies.
Abstract

Keywords:
ST-segment–elevation myocardial infarctionhumansmagnetic resonanceprognosis

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