TY - JOUR
T1 - Prognostic stratification of patients with ST-segment-elevation myocardial infarction (PROSPECT)
T2 - A cardiac magnetic resonance study
AU - Pontone, Gianluca
AU - Guaricci, Andrea I.
AU - Andreini, Daniele
AU - Ferro, Giovanni
AU - Guglielmo, Marco
AU - Baggiano, Andrea
AU - Fusini, Laura
AU - Muscogiuri, Giuseppe
AU - Lorenzoni, Valentina
AU - Mushtaq, Saima
AU - Conte, Edoardo
AU - Annoni, Andrea
AU - Formenti, Alberto
AU - Mancini, Maria Elisabetta
AU - Carità, Patrizia
AU - Verdecchia, Massimo
AU - Pica, Silvia
AU - Fazzari, Fabio
AU - Cosentino, Nicola
AU - Marenzi, Giancarlo
AU - Rabbat, Mark G.
AU - Agostoni, Piergiuseppe
AU - Bartorelli, Antonio L.
AU - Pepi, Mauro
AU - Masci, Pier Giorgio
N1 - Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/11
Y1 - 2017/11
N2 - 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, 61.4±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 2.5±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.
AB - 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, 61.4±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 2.5±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.
KW - Humans
KW - Magnetic resonance
KW - Prognosis
KW - ST-segment-elevation myocardial infarction
UR - https://www.scopus.com/pages/publications/85037707090
U2 - 10.1161/CIRCIMAGING.117.006428
DO - 10.1161/CIRCIMAGING.117.006428
M3 - Article
C2 - 29146587
AN - SCOPUS:85037707090
SN - 1941-9651
VL - 10
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
IS - 11
M1 - e006428
ER -