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Histological Quantification of Chronic Myocardial Infarct in Rats
Published on: December 11, 2016
Simple indices of infarct size post ST-Elevation Myocardial Infarction (STEMI) provides similar risk stratification
Lokesh Sharma1,2, Amir Faour1,2, Tuan Nguyen1,2
1Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia.
Insights
High-sensitivity Troponin T levels and QRS scoring effectively assess infarct size after ST-elevation myocardial infarction (STEMI). These methods predict major adverse cardiac events (MACE) at 24 months, aiding in patient risk stratification.
Area of Science:
- Cardiology
- Biomarkers
- Medical Imaging
Background:
- Myocardial Infarct Size (IS) after ST-elevation myocardial infarction (STEMI) is a key prognostic indicator.
- IS can be assessed using cardiac biomarkers, electrocardiography (ECG), and imaging like echocardiography and cardiac magnetic resonance imaging (CMRI).
Purpose of the Study:
- To evaluate methods for assessing IS in STEMI patients post-percutaneous coronary intervention (PCI).
- To compare 12-lead ECG Selvester QRS scores and high-sensitivity Troponin T (hsTnT) levels with CMRI and echocardiography.
- To determine the association between IS and 24-month major adverse cardiac events (MACE).
Main Methods:
- Prospective cohort study of STEMI patients undergoing PCI.
- Assessment of IS using CMRI, echocardiography, Selvester QRS scores, and hsTnT levels measured ≥48 hours post-STEMI.
- Analysis of correlations between IS assessment methods and 24-month MACE (death, stroke, heart failure hospitalization).
Main Results:
- Early CMRI was performed on 233 STEMI patients; 211 had first STEMIs, with a median age of 56.
- Plateau phase hsTnT levels, QRS scoring, and CMRI-determined IS correlated significantly for anterior MIs (r>0.4, p<0.01).
- Highest tertiles of hsTnT, QRS score, and CMRI-IS predicted 24-month MACE (log-rank <0.01); 72h hsTnT levels predicted MACE (p<0.01).
Conclusions:
- Post-PCI hsTnT levels (≥48h) and Selvester QRS scoring correlate with CMRI-defined IS in STEMI.
- These parameters serve as reliable predictors of 24-month MACE.
- Routine assessment of hsTnT and QRS scoring is recommended for post-STEMI risk stratification.
Introduction:
Myocardial Infarct Size (IS) determined soon after ST-segment elevation myocardial infarction (STEMI) has prognostic significance, and can be assessed by cardiac biomarker levels, electrocardiographic (ECG) parameters, and imaging modalities (including echocardiography and cardiac magnetic resonance imaging [CMRI]).
Objectives And Methods:
We evaluated methods of IS assessment, 12-lead ECG Selvester QRS scores and high-sensitivity Troponin T (hsTnT) levels measured ≥48hr (plateau phase of hsTnT elevation), compared to paired CMRIs and echocardiograms, in a prospective cohort of patients with STEMI undergoing percutaneous coronary intervention (PCI) during the index hospitalisation. Associations were determined between IS, as assessed by these methods, and 24-month major adverse cardiac events (MACE), a hierarchical composite of: death, stroke and hospitalization for heart failure.
Results:
Of 233 patients undergoing early CMRI after STEMI, 211 patients (86% male; 54% anterior MI) had first STEMIs, median age 56 years [interquartile range 50-64], of whom 165 (78%) underwent primary PCI and 46 (22%) pharmaco-invasive PCI. Ejection fraction improved from 48% [42-54] acutely to 52% [44-60] at 2 months (p< 0.05). Plateau phase hsTnT levels, QRS scoring and CMRI-determined IS post-STEMI correlated for anterior MIs (all comparisons r>0.4, p<0.01); highest tertiles of these 3 parameters predicted 24 month MACE (log-rank <0.01). Multi-variable binary logistic regression analysis showed 72h hsTnT levels predicted 24-month MACE (p<0.01).
Conclusion:
Post-PCI treatment of STEMI, hsTnT levels measured ≥48h and Selvester QRS scoring correlated with CMRI-determined IS. These parameters predicted MACE at 24 months and should be routinely assessed for post-STEMI risk stratification.
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