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Prognosis after ST-elevation myocardial infarction: a study on cardiac magnetic resonance imaging versus clinical routine.
- Source :
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Trials [Trials] 2014 Jun 25; Vol. 15, pp. 249. Date of Electronic Publication: 2014 Jun 25. - Publication Year :
- 2014
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Abstract
- Background: This study aimed to evaluate the incremental prognostic value of infarct size, microvascular obstruction (MO), myocardial salvage index (MSI), and left ventricular ejection fraction (LV-EFCMR) assessed by cardiac magnetic resonance imaging (CMR) in comparison to traditional outcome markers in patients with ST-elevation myocardial infarction (STEMI) reperfused by primary percutaneous intervention (PCI).<br />Methods: STEMI patients reperfused by primary PCI (n=278) within 12 hours after symptom onset underwent CMR three days after the index event (interquartile range [IQR] two to four). Infarct size and MO were measured 15 minutes after gadolinium injection. T2-weighted and contrast-enhanced CMR were used to calculate MSI. In addition, traditional outcome markers such as ST-segment resolution, pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI)-flow, maximum level of creatine kinase-MB, TIMI-risk score, and left ventricular ejection fraction assessed by echocardiography were determined in all patients. Clinical follow-up was conducted after 19 months (IQR 10 to 27). The primary endpoint was defined as a composite of death, myocardial reinfarction, and congestive heart failure (MACE).<br />Results: In multivariable Cox regression analysis, adjusting for all traditional outcome parameters significantly associated with the primary endpoint in univariable analysis, MSI was identified as an independent predictor for the occurrence of MACE (Hazard ratio 0.94, 95% CI 0.92 to 0.96, P<0.001). Further, C-statistics comparing a model including only traditional outcome markers to a model including CMR parameters on top of traditional outcome markers revealed an incremental prognostic value of CMR parameters (0.74 versus 0.94, P<0.001).<br />Conclusions: CMR parameters such as infarct size, MO, MSI, and LV-EFCMR add incremental prognostic value above traditional outcome markers alone in acute reperfused STEMI.<br />Trial Registration: Clinicaltrials.gov NCT00463749, Clinicaltrials.gov NCT00359918.
- Subjects :
- Aged
Chi-Square Distribution
Clinical Trials as Topic
Contrast Media
Coronary Circulation
Female
Germany
Heart Failure etiology
Humans
Male
Microcirculation
Middle Aged
Multivariate Analysis
Myocardial Infarction mortality
Myocardial Infarction pathology
Myocardial Infarction physiopathology
Organometallic Compounds
Predictive Value of Tests
Proportional Hazards Models
Recurrence
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Magnetic Resonance Imaging
Myocardial Infarction therapy
Myocardium pathology
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Stroke Volume
Ventricular Function, Left
Subjects
Details
- Language :
- English
- ISSN :
- 1745-6215
- Volume :
- 15
- Database :
- MEDLINE
- Journal :
- Trials
- Publication Type :
- Academic Journal
- Accession number :
- 24962156
- Full Text :
- https://doi.org/10.1186/1745-6215-15-249