The Prognostic Value of Echocardiographic Wall Motion Score Index in ST-Segment Elevation Myocardial Infarction
Michael L Savage1,2, Karen Hay1,3, Bonita Anderson1
1Cardiology Department, The Prince Charles Hospital, Brisbane, QLD, Australia.
Insights
Wall motion score index (WMSI) better predicts 12-month mortality than left ventricular ejection fraction (LVEF) in ST-segment elevation myocardial infarction (STEMI) patients. Both WMSI and LVEF show strong prognostic value in multivariable models for STEMI mortality.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Outcomes
Background:
- Left ventricular ejection fraction (LVEF) is a standard metric for cardiac function.
- Wall motion score index (WMSI) has shown promise in predicting cardiac events post-myocardial infarction.
- Limited data exists on WMSI's prognostic value for mortality in ST-segment elevation myocardial infarction (STEMI) patients.
Purpose of the Study:
- To compare the prognostic capability of WMSI versus LVEF in predicting 12-month all-cause mortality.
- To evaluate the predictive performance of WMSI and LVEF in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- To assess the utility of WMSI and LVEF against established risk scores (TIMI, GRACE) for mortality prediction.
Main Methods:
- A cohort of 1181 STEMI patients treated with primary PCI between 2008 and 2020 was analyzed.
- Prognostic values of WMSI and LVEF were compared with all-cause mortality at 12 months.
- Multivariable logistic regression models were used to compare WMSI, LVEF, and traditional risk scores (TIMI, GRACE).
Main Results:
- WMSI ≥1.8 was significantly associated with poorer 12-month survival (9.2% vs 1.5%, p < 0.001).
- WMSI demonstrated superior discriminatory ability (AUC: 0.77) compared to LVEF (AUC: 0.71, p=0.034) for predicting 12-month mortality individually.
- Multivariable models showed comparable performance for WMSI (AUC: 0.89) and LVEF (AUC: 0.87), both significantly outperforming TIMI (AUC: 0.71) and GRACE (AUC: 0.63) scores.
Conclusions:
- WMSI is a superior individual predictor of 12-month mortality compared to LVEF in STEMI patients post-PCI.
- Both WMSI and LVEF are valuable predictors of mortality when incorporated into multivariable models for STEMI.
- WMSI and LVEF offer improved prognostic insights over traditional risk scores like TIMI and GRACE in this patient population.
Background:
When compared to left ventricular ejection fraction (LVEF), previous studies have suggested the superiority of wall motion score index (WMSI) in predicting cardiac events in patients who have suffered acute myocardial infarction. However, there are limited studies assessing WMSI and mortality in ST-segment elevation myocardial infarction (STEMI). We aimed to compare the prognostic value of WMSI in a cohort of STEMI patients treated with primary percutaneous coronary intervention (PCI).
Methods:
A comparison of WMSI, LVEF, and all-cause mortality in STEMI patients treated with primary PCI between January 2008 and December 2020 was performed. The prognostic value of WMSI, LVEF, and traditional risk scores (TIMI, GRACE) were compared using multivariable logistic regression modelling.
Results:
Among 1181 patients, 27 died within 30-days (2.3%) and 49 died within 12 months (4.2%). WMSI ≥1.8 was associated with poorer survival at 12-months (9.2% vs 1.5%; p < 0.001). When used as the only classifier for predicting 12-month mortality, the discriminatory ability of WMSI (area under the curve (AUC): 0.77; 95% CI: 0.68-0.84) was significantly better than LVEF (AUC: 0.71; 95% CI: 0.61-0.79; p=0.034). After multivariable modelling, the AUC was comparable between models with either WMSI (AUC: 0.89; 95% CI: 0.85-0.94) or LVEF (AUC: 0.87; 95% CI: 0.83-0.92; p < 0.08) yet performed significantly better than TIMI (AUC: 0.71; 95% CI: 0.62-0.79; p < 0.001), or GRACE (AUC: 0.63; 95% CI: 0.54-0.71; p < 0.001) risk scores.
Conclusions:
When examined individually, WMSI is a superior predictor of 12-month mortality over LVEF in STEMI patients treated with primary PCI. When examined in multivariable predictive models, WMSI and LVEF perform very well at predicting 12-month mortality, especially when compared to existing STEMI risk scores.
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