ST段抬高型心肌梗死后的预后：心脏磁共振成像与临床常规方法的对比研究
Prognosis after ST-elevation myocardial infarction: a study on cardiac magnetic resonance imaging versus clinical routine.
作者信息
de Waha Suzanne, Eitel Ingo, Desch Steffen, Fuernau Georg, Lurz Philipp, Stiermaier Thomas, Blazek Stephan, Schuler Gerhard, Thiele Holger
机构信息
Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Strümpellstr, 39, 04289 Leipzig, Germany.
出版信息
Trials. 2014 Jun 25;15:249. doi: 10.1186/1745-6215-15-249.
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.
背景
本研究旨在评估通过心脏磁共振成像（CMR）评估的梗死面积、微血管阻塞（MO）、心肌挽救指数（MSI）和左心室射血分数（LV-EFCMR）相对于传统预后指标在接受直接经皮冠状动脉介入治疗（PCI）再灌注的ST段抬高型心肌梗死（STEMI）患者中的增量预后价值。
方法
症状发作后12小时内接受直接PCI再灌注的STEMI患者（n = 278）在首次事件发生三天后（四分位间距[IQR]为2至4天）接受CMR检查。钆注射后15分钟测量梗死面积和MO。使用T2加权和对比增强CMR计算MSI。此外，在所有患者中测定传统预后指标，如ST段分辨率、PCI前后心肌梗死溶栓（TIMI）血流、肌酸激酶-MB最高水平、TIMI风险评分以及通过超声心动图评估的左心室射血分数。19个月后（IQR为10至27个月）进行临床随访。主要终点定义为死亡、心肌再梗死和充血性心力衰竭的复合终点（MACE）。
结果
在多变量Cox回归分析中，在单变量分析中对与主要终点显著相关的所有传统预后参数进行校正后，MSI被确定为MACE发生的独立预测因素（风险比0.94，95%CI为0.92至0.96，P<0.001）。此外，将仅包含传统预后指标的模型与包含传统预后指标以及CMR参数的模型进行比较的C统计量显示，CMR参数具有增量预后价值（0.74对0.94，P<0.001）。
结论
在急性再灌注STEMI中，梗死面积、MO、MSI和LV-EFCMR等CMR参数相对于单独的传统预后指标具有增量预后价值。
试验注册
Clinicaltrials.gov NCT00463749，Clinicaltrials.gov NCT00359918。
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