Ten-year prognostic impact of cardiac magnetic resonance endpoints in patients with ST-segment elevation myocardial
Ben Elezi1, Jasmine Melissa Marquard1, Henning Kelbæk2
1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark.
Insights
Smaller infarct size (IS) and higher myocardial salvage index (MSI) after ST-segment elevation myocardial infarction (STEMI) predict better 10-year outcomes. These cardiac magnetic resonance (CMR) markers are crucial for long-term prognosis, unlike microvascular obstruction (MVO).
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Outcomes Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring accurate prognostic markers.
- Cardiac magnetic resonance (CMR) offers detailed assessment of myocardial damage, including infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI).
- The long-term prognostic value of these CMR-derived parameters in STEMI patients needs further elucidation.
Purpose of the Study:
- To evaluate the association between acute and 3-month infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) with 10-year clinical outcomes in STEMI patients.
- To determine the predictive significance of left ventricular ejection fraction (LVEF) and transmurality on long-term mortality and heart failure hospitalization post-STEMI.
Main Methods:
- Prospective cohort study involving 811 STEMI patients.
- Cardiac magnetic resonance (CMR) imaging performed during admission and at 3 months to quantify IS, MSI, LVEF, MVO, and transmurality.
- Adjusted Cox regression models analyzed the association between CMR endpoints and the composite outcome of all-cause mortality or heart failure hospitalization over a median follow-up of 10.9 years.
Main Results:
- A total of 173 patients (21%) experienced the composite outcome.
- Smaller acute and 3-month IS, higher acute and 3-month MSI, higher acute and 3-month LVEF, and smaller acute and 3-month transmurality were significant predictors of better outcomes.
- Microvascular obstruction (MVO) did not show a significant association with the composite outcome.
Conclusions:
- Acute and 3-month infarct size, myocardial salvage index, left ventricular ejection fraction, and transmurality assessed by CMR are independent predictors of 10-year mortality and heart failure hospitalization in STEMI patients.
- Microvascular obstruction (MVO) is not a significant predictor of these long-term outcomes.
- These findings highlight the prognostic importance of infarct size and myocardial salvage in STEMI management.
Aims:
The study aimed to investigate the importance of infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) on the 10-year outcome in patients with ST-segment elevation myocardial infarction (STEMI).
Methods And Results:
Patients with STEMI had cardiac magnetic resonance (CMR) performed during admission and after 3 months to assess acute and 3-month IS, MSI, left ventricular ejection fraction (LVEF), MVO and transmurality. Adjusted Cox regression models were used to investigate the association between CMR endpoints and all-cause mortality or hospitalization for heart failure 10 years after STEMI. A total of 811 patients had either acute or follow-up CMR performed. During median follow-up of 10.9 years, 173 (21%) patients died or were hospitalized for heart failure. Acute IS [adjusted hazard ratio (HR): 1.02; 95%-confidence interval (CI): 1.01-1.04; P = 0.005], 3-month IS (adjusted HR: 1.04; 95%-CI: 1.02-1.06; P < 0.001), acute MSI (adjusted HR: 0.99; 95%-CI: 0.98-1.00; P = 0.007), 3-month MSI (adjusted HR: 0.99; 95%-CI: 0.98-1.00; P = 0.004), acute LVEF (adjusted HR: 0.97; 95%-CI: 0.95-0.99; P = 0.001), 3-month LVEF (adjusted HR: 0.95; 95%-CI: 0.93-0.97; P < 0.001), acute transmurality (adjusted HR: 1.01; 95%-CI: 1.00-1.02; P = 0.024), and 3-month transmurality (adjusted HR: 1.01; 95%-CI: 1.00-1.02; P = 0.003) were all significant predictors of the composite outcome. MVO was not associated with the composite outcome (adjusted HR: 1.04; 95%-CI: 0.98-1.09; P = 0.20).
Conclusion:
Smaller IS, smaller transmurality, higher MSI, and higher LVEF measured acutely and 3 months after STEMI were independently associated with lower all-cause mortality and/or hospitalization for heart failure within 10 years after STEMI, whereas MVO was not.
Clinical Trial Registration:
Registered with ClinicalTrials.gov (identifiers: NCT01435408 and NCT01960933).
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