Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study.

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. 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. 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.

Pontone G ，Guaricci AI ，Andreini D ，Ferro G ，Guglielmo M ，Baggiano A ，Fusini L ，Muscogiuri G ，Lorenzoni V ，Mushtaq S ，Conte E ，Annoni A ，Formenti A ，Mancini ME ，Carità P ，Verdecchia M ，Pica S ，Fazzari F ，Cosentino N ，Marenzi G ，Rabbat MG ，Agostoni P ，Bartorelli AL ，Pepi M ，Masci PG ... -  《-》

Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction.

Marcos-Garces V ，Gavara J ，Lopez-Lereu MP ，Monmeneu JV ，Rios-Navarro C ，de Dios E ，Perez N ，Cànoves J ，Gonzalez J ，Minana G ，Nunez J ，de la Espriella R ，Santas E ，Moratal D ，Chorro FJ ，Valente F ，Lorenzatti D ，Rodríguez-Palomares JF ，Ortiz-Pérez JT ，Bodi V ... -  《-》

Optimized Prognosis Assessment in ST-Segment-Elevation Myocardial Infarction Using a Cardiac Magnetic Resonance Imaging Risk Score.

Cardiac magnetic resonance (CMR) demonstrated great potential for the prediction of major adverse cardiac events (MACE) in ST-segment-elevation myocardial infarction. The aim of this study was to develop and validate a CMR-based risk score for ST-segment-elevation myocardial infarction patients. The scoring model was developed and validated on ST-segment-elevation myocardial infarction cohorts from 2 independent randomized controlled trials (n=738 and n=458 patients, respectively) and included left ventricular (LV) ejection fraction, infarct size, and microvascular obstruction. Primary end point was the 12-month MACE rate consisting of death, reinfarction, and new congestive heart failure. In the derivation cohort, LV ejection fraction ≤47%, infarct size ≥19%LV, and microvascular obstruction ≥1.4%LV were identified as the best cutoff values for MACE prediction. According to the hazard ratios in multivariable regression analysis, the CMR risk score was created by attributing 1 point for LV ejection fraction ≤47%, 1 point for infarct size ≥19%LV, and 2 points for microvascular obstruction ≥1.4%LV. In the validation cohort, the score showed a good prediction of MACE (area under the curve: 0.76). Stratification into a low (0/1 point) and high-risk group (≥2 points) resulted in significantly higher MACE rates in high-risk patients (9.0% versus 2.2%; P=0.001). Inclusion of the CMR score in addition to a model of clinical risk factors led to a significant increase of C statistics from 0.74 to 0.83 (P=0.037), a net reclassification improvement of 0.18 (P=0.009), and an integrated discriminative improvement of 0.04 (P=0.010). Our approach integrates the prognostic information of CMR imaging into a simple risk score that showed incremental prognostic value over clinical risk factors in ST-segment-elevation myocardial infarction patients. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00712101 and NCT02158468.

Stiermaier T ，Jobs A ，de Waha S ，Fuernau G ，Pöss J ，Desch S ，Thiele H ，Eitel I ... -  《-》

Prognostic Implications of Global Longitudinal Strain by Feature-Tracking Cardiac Magnetic Resonance in ST-Elevation Myocardial Infarction.

Reindl M ，Tiller C ，Holzknecht M ，Lechner I ，Beck A ，Plappert D ，Gorzala M ，Pamminger M ，Mayr A ，Klug G ，Bauer A ，Metzler B ，Reinstadler SJ ... -  《-》

Microvascular obstruction extent predicts major adverse cardiovascular events in patients with acute myocardial infarction and preserved ejection fraction.

Galea N ，Dacquino GM ，Ammendola RM ，Coco S ，Agati L ，De Luca L ，Carbone I ，Fedele F ，Catalano C ，Francone M ... -  《-》