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Open Access Research

Prognosis after ST-elevation myocardial infarction: a study on cardiac magnetic resonance imaging versus clinical routine

Suzanne de Waha12*, Ingo Eitel3, Steffen Desch3, Georg Fuernau1, Philipp Lurz1, Thomas Stiermaier1, Stephan Blazek1, Gerhard Schuler1 and Holger Thiele3

Author Affiliations

1 Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany

2 Department of Cardiology and Angiology, Heart Center Bad Segeberg, Am Kurpark 1, 23795 Bad Segeberg, Germany

3 Medical Clinic II, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany

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Trials 2014, 15:249  doi:10.1186/1745-6215-15-249

Published: 25 June 2014

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).

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).

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).

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.

Trial registration

Clinicaltrials.gov NCT00463749, Clinicaltrials.gov NCT00359918.

Keywords:
ST-elevation myocardial infarction; Prognosis; Traditional outcome markers; Cardiac magnetic resonance imaging