TY - JOUR
T1 - Early or deferred cardiovascular magnetic resonance after ST-segment-elevation myocardial infarction for effective risk stratification
AU - Masci, Pier Giorgio
AU - Pavon, Anna Giulia
AU - Pontone, Gianluca
AU - Symons, Rolf
AU - Lorenzoni, Valentina
AU - Francone, Marco
AU - Zalewski, Jaroslaw
AU - Barison, Andrea
AU - Guglielmo, Marco
AU - Aquaro, Giovanni Donato
AU - Galea, Nicola
AU - Muscogiuri, Giuseppe
AU - Muller, Olivier
AU - Carbone, Iacopo
AU - Baggiano, Andrea
AU - Iglesias, Juan F.
AU - Nessler, Jadwiga
AU - Andreini, Daniele
AU - Camici, Paolo G.
AU - Claus, Piet
AU - De Luca, Laura
AU - Agati, Luciano
AU - Janssens, Stefan
AU - Schwitter, Jurg
AU - Bogaert, Jan
N1 - Publisher Copyright:
© 2019 Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Aims: In ST-segment-elevation myocardial infarction (STEMI), cardiovascular magnetic resonance (CMR) holds the potentiality to improve risk stratification in addition to Thrombolysis in Myocardial Infarction (TIMI) risk score. Nevertheless, the optimal timing for CMR after STEMI remains poorly defined. We aim at comparing the prognostic performance of three stratification strategies according to the timing of CMR after STEMI. Methods and results: The population of this prospective registry-based study included 492 reperfused STEMI patients. All patients underwent post-reperfusion (median: 4 days post-STEMI) and follow-up (median: 4.8 months post-STEMI) CMR. Left ventricular (LV) volumes, function, infarct size, and microvascular obstruction extent were quantified. Primary endpoint was a composite of all-death and heart failure (HF) hospitalization. Baseline-to-follow-up percentage increase of LV end-diastolic (EDV; DLV-EDV) =20% or end-systolic volumes (ESV; DLV-ESV) =15% were tested against outcome. Three multivariate models were developed including TIMI risk score plus early post-STEMI (early-CMR) or follow-up CMR (deferred-CMR) or both CMRs parameters along with adverse LV remodelling (paired-CMRs). During a median follow-up of 8.3 years, the primary endpoint occurred in 84 patients (47 deaths; 37 HF hospitalizations). Early-CMR, deferred-CMR, and paired-CMR demonstrated similar predictive value for the primary endpoint (C-statistic: 0.726, 0.728, and 0.738, respectively; P = 0.663). DLV-EDV =20% or DLV-ESV =15% were unadjusted outcome predictors (hazard ratio: 2.020 and 2.032, respectively; P = 0.002 for both) but lost their predictive value when corrected for other covariates in paired-CMR model. Conclusion: In STEMI patients, early-, deferred-, or paired-CMR were equivalent stratification strategies for outcome prediction. Adverse LV remodelling parameters were not independent prognosticators.
AB - Aims: In ST-segment-elevation myocardial infarction (STEMI), cardiovascular magnetic resonance (CMR) holds the potentiality to improve risk stratification in addition to Thrombolysis in Myocardial Infarction (TIMI) risk score. Nevertheless, the optimal timing for CMR after STEMI remains poorly defined. We aim at comparing the prognostic performance of three stratification strategies according to the timing of CMR after STEMI. Methods and results: The population of this prospective registry-based study included 492 reperfused STEMI patients. All patients underwent post-reperfusion (median: 4 days post-STEMI) and follow-up (median: 4.8 months post-STEMI) CMR. Left ventricular (LV) volumes, function, infarct size, and microvascular obstruction extent were quantified. Primary endpoint was a composite of all-death and heart failure (HF) hospitalization. Baseline-to-follow-up percentage increase of LV end-diastolic (EDV; DLV-EDV) =20% or end-systolic volumes (ESV; DLV-ESV) =15% were tested against outcome. Three multivariate models were developed including TIMI risk score plus early post-STEMI (early-CMR) or follow-up CMR (deferred-CMR) or both CMRs parameters along with adverse LV remodelling (paired-CMRs). During a median follow-up of 8.3 years, the primary endpoint occurred in 84 patients (47 deaths; 37 HF hospitalizations). Early-CMR, deferred-CMR, and paired-CMR demonstrated similar predictive value for the primary endpoint (C-statistic: 0.726, 0.728, and 0.738, respectively; P = 0.663). DLV-EDV =20% or DLV-ESV =15% were unadjusted outcome predictors (hazard ratio: 2.020 and 2.032, respectively; P = 0.002 for both) but lost their predictive value when corrected for other covariates in paired-CMR model. Conclusion: In STEMI patients, early-, deferred-, or paired-CMR were equivalent stratification strategies for outcome prediction. Adverse LV remodelling parameters were not independent prognosticators.
KW - Cardiovascular magnetic resonance
KW - Risk stratification
KW - ST-segment elevation myocardial infarction
KW - TIMI risk score
UR - http://www.scopus.com/inward/record.url?scp=85085233472&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jez179
DO - 10.1093/ehjci/jez179
M3 - Article
C2 - 31326993
AN - SCOPUS:85085233472
SN - 2047-2404
VL - 21
SP - 632
EP - 639
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 6
ER -