Background-Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement. Methods and Results-Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61.4Â±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5Â±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score (P<0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE (P<0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311-2.658]; P<0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement. Conclusions-CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiography-LVEF and may impact the management of patients with ST-segment-elevation myocardial infarction.
Prognostic stratification of patients with ST-segment-elevation myocardial infarction (PROSPECT) : A cardiac magnetic resonance study / G. Pontone, G. Andrea I., D. Andreini, F. Giovanni, G. Marco, A. Baggiano, L. Fusini, M. Giuseppe, L. Valentina, S. Mushtaq, E. Conte, A. Andrea, A. Formenti, M. Maria Elisabetta, C. Patrizia, V. Massimo, P. Silvia, F. Fabio, C. Nicola, M. Giancarlo, R. Mark G., P. Agostoni, A.L. Bartorelli, P. Mauro, M. Pier Giorgio. - In: CIRCULATION. CARDIOVASCULAR IMAGING. - ISSN 1941-9651. - 10:11(2017 Nov).
|Titolo:||Prognostic stratification of patients with ST-segment-elevation myocardial infarction (PROSPECT) : A cardiac magnetic resonance study|
|Parole Chiave:||humans; magnetic resonance; prognosis; st-segment-elevation myocardial infarction; aged; chi-square distribution; coronary angiography; coronary circulation; echocardiography; female; hemorrhage; humans; male; microcirculation; middle aged; multivariate analysis; percutaneous coronary intervention; predictive value of tests; proportional hazards models; risk factors; st elevation myocardial infarction; stroke volume; time factors; treatment outcome; ventricular function, left; magnetic resonance imaging, cine; radiology, nuclear medicine and imaging; cardiology and cardiovascular medicine|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||nov-2017|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1161/CIRCIMAGING.117.006428|
|Appare nelle tipologie:||01 - Articolo su periodico|