Department of Internal Medicine, University of Leipzig, Heart Center, Leipzig, Germany.
Heart. 2011 Dec;97(24):2038-45. doi: 10.1136/heartjnl-2011-300098. Epub 2011 Oct 11.
In acute myocardial infarction, cardiovascular magnetic resonance (CMR) allows for quantifying the extent of salvaged myocardium after reperfusion as a potential strong end point for clinical trials. The aim of this study was to investigate whether the early prognostic significance of myocardial salvage assessed by CMR is sustained at long-term clinical follow-up in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty.
DESIGN, SETTING, PATIENTS: We analysed 208 consecutive patients with STEMI 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 categorised into two groups defined by the median MSI. The primary end point was the occurrence of major adverse cardiovascular events defined as death, reinfarction and new congestive heart failure at long-term follow-up.
The median MSI was 48 (IQR 27 to 73). Long-term follow-up was available in 202 patients (97%) at a median of 18.5 months (IQR 13.8 to 20.8). Major adverse cardiovascular events occurred in 33 patients (16%), with a significantly lower event rate in the MSI ≥ median group (7 vs 26 events, p<0.001). Mortality was significantly reduced in the MSI ≥ median group (2 vs 12 deaths, p = 0.001). MSI was a significant independent predictor for a favourable long-term survival on multivariable Cox regression analysis after adjustment for established prognostic markers.
MSI assessed by CMR predicts long-term clinical outcome in acute reperfused STEMI. Therefore, our data support the use of myocardial salvage as an end point for clinical trials investigating novel reperfusion strategies. Trial registration number http://www.ClinicalTrials.gov: NCT00952224.
在急性心肌梗死中，心血管磁共振（CMR）可量化再灌注后存活心肌的范围，作为临床试验的潜在强终点。本研究旨在探讨在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，CMR 评估的心肌挽救程度的早期预后意义是否在长期临床随访中持续存在。
设计、地点、患者：我们分析了 208 例 STEMI 患者，这些患者在症状发作后 <12 小时内行直接 PCI。采用 T2 加权和对比增强 CMR 计算心肌挽救指数（MSI）。患者根据 MSI 的中位数分为两组。主要终点是长期随访时发生的主要不良心血管事件，定义为死亡、再梗死和新发充血性心力衰竭。
MSI 的中位数为 48（IQR 27 至 73）。中位随访时间为 18.5 个月（IQR 13.8 至 20.8），202 例患者（97%）可获得长期随访。33 例患者（16%）发生主要不良心血管事件，MSI≥中位数组的事件发生率显著较低（7 例与 26 例事件，p<0.001）。MSI≥中位数组的死亡率显著降低（2 例与 12 例死亡，p=0.001）。多变量 Cox 回归分析调整了既定预后标志物后，MSI 是长期生存的独立预测因子。
CMR 评估的 MSI 可预测急性再灌注 STEMI 的长期临床结局。因此，我们的数据支持将心肌挽救作为评估新再灌注策略临床试验的终点。试验注册编号：http://www.ClinicalTrials.gov：NCT00952224。
