Prognostic stratification of patients with ST-segment-elevation myocardial infarction (PROSPECT): A cardiac magnetic resonance study

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 Mancini, Patrizia Carità, Massimo Verdecchia, Silvia Pica, Fabio Fazzari, Nicola Cosentino, Giancarlo MarenziMark G. Rabbat, Piergiuseppe Agostoni, Antonio L. Bartorelli, Mauro Pepi, Pier Giorgio Masci

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Article numbere006428
JournalCirculation: Cardiovascular Imaging
Volume10
Issue number11
DOIs
Publication statusPublished - Nov 1 2017

    Fingerprint

Keywords

  • Humans
  • Magnetic resonance
  • Prognosis
  • ST-segment-elevation myocardial infarction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this