Heart Center, Department of Internal Medicine-Cardiology, University of Leipzig, Leipzig, Germany.
J Am Coll Cardiol. 2010 Jun 1;55(22):2470-9. doi: 10.1016/j.jacc.2010.01.049.
The aim of the study was to determine the prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance (CMR) in reperfused ST-segment elevation myocardial infarction.
In acute myocardial infarction, CMR can retrospectively detect the myocardium at risk and the irreversible injury. This allows for quantifying the extent of salvaged myocardium after reperfusion as a potential strong end point for clinical trials and outcome.
We analyzed 208 consecutive ST-segment elevation myocardial infarction patients undergoing primary angioplasty <12 h after symptom onset. T2-weighted and contrast-enhanced CMR was used to calculate the myocardial salvage index (MSI). Patients were categorized into 2 groups defined by the median MSI. The primary end point of the study was occurrence of major adverse cardiovascular events defined as death, reinfarction, and occurrence of new congestive heart failure within 6 months after the index event.
The median MSI was 48 (interquartile range 27 to 73). Major adverse cardiovascular events were significantly lower in the MSI >or= median group (2.9% vs. 22.1%, p < 0.001). The stepwise Cox proportional hazards model revealed that the MSI was the strongest predictor of major adverse cardiovascular events at 6-month follow-up (p < 0.001). All prognostic clinical (symptom onset to reperfusion), angiographic (Thrombolysis In Myocardial Infarction flow grade before angioplasty), and electrocardiographic (ST-segment resolution) parameters showed significant correlations with the MSI (p < 0.001 for all).
This study for the first time demonstrates that the MSI assessed by CMR predicts the outcome in acute reperfused ST-segment elevation myocardial infarction. Therefore, MSI assessment has important implications for patient prognosis as well as for the design of future trials intended to test new reperfusion therapy efficacy. (Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance-Impact on Outcome; NCT00952224).
本研究旨在探讨经心血管磁共振（CMR）评估的心肌再灌注后心肌挽救程度的预后意义及其决定因素。
在急性心肌梗死中，CMR 可回顾性检测危险心肌和不可逆损伤，从而量化再灌注后心肌挽救程度，作为临床试验和预后的潜在强终点。
我们分析了 208 例发病 12 小时内接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者。采用 T2 加权和对比增强 CMR 计算心肌挽救指数（MSI）。根据 MSI 的中位数将患者分为两组。本研究的主要终点是发生主要不良心血管事件，定义为指数事件后 6 个月内死亡、再梗死和新发充血性心力衰竭。
MSI 的中位数为 48（四分位间距 27 至 73）。MSI≥中位数组的主要不良心血管事件发生率显著较低（2.9%比 22.1%，p<0.001）。逐步 Cox 比例风险模型显示，MSI 是 6 个月随访时发生主要不良心血管事件的最强预测因素（p<0.001）。所有预后临床（症状发作至再灌注）、血管造影（经皮冠状动脉介入治疗前的血栓溶解心肌梗死血流分级）和心电图（ST 段回落）参数与 MSI 均呈显著相关（p<0.001）。
本研究首次证明 CMR 评估的 MSI 可预测急性再灌注 ST 段抬高型心肌梗死的预后。因此，MSI 评估对患者预后以及未来旨在检验新再灌注治疗疗效的试验设计具有重要意义。（心血管磁共振评估的心肌挽救-对预后的影响；NCT00952224）。
