Prognostic Stratification of Patients With ST-Segment–Elevation Myocardial Infarction (PROSPECT)

• DOI: 10.1161/circimaging.117.006428
• Publication Date: 2017-11-17T01:10:35Z
• Authors: Gianluca Pontone; Andrea I. Guaricci; Daniele Andreini; Giovanni Ferro; Marco Guglielmo; Andrea Baggiano; Laura Fusini; Giuseppe Muscogiuri; Valentina Lorenzoni; Saima Mushtaq; Edoardo Conte; Andrea Annoni; Alberto Formenti; Maria Elisabetta ...; Patrizia Carità; Massimo Verdecchia; Silvia Pica; Fabio Fazzari; Nicola Cosentino; Giancarlo Marenzi; Mark G. Rabbat; Piergiuseppe Agos...; Antonio L. Bartor...; Mauro Pepi; Pier Giorgio Masci
• Keywords: Male; Time Factors; Magnetic Resonance Imaging, Cine; Hemorrhage; Coronary Angiography; magnetic resonance; 03 medical and health sciences; Percutaneous Coronary Intervention; 0302 clinical medicine; ST-segment–elevation myocardial infarction; 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; Predictive Value of Tests; Risk Factors; Coronary Circulation; Humans; human; Aged; Proportional Hazards Models; Chi-Square Distribution; Microcirculation; Stroke Volume; Middle Aged; Humans; Magnetic resonance; Prognosis; ST-segment-elevation myocardial infarction;; 3. Good health; Echocardiography; Multivariate Analysis; ST Elevation Myocardial Infarction; Female; prognosis; 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

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.