Gasthuisberg University Hospitals, Leuven, Belgium.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
JACC Cardiovasc Imaging. 2018 Jun;11(6):813-825. doi: 10.1016/j.jcmg.2017.05.023. Epub 2017 Aug 16.
This study sought to investigate whether early post-infarction cardiac magnetic resonance (CMR) parameters provide additional long-term prognostic value beyond traditional outcome predictors in ST-segment elevation myocardial infarction (STEMI) patients.
Long-term prognostic significance of CMR in STEMI patients has not been assessed yet.
This was a longitudinal study from a multicenter registry that prospectively included STEMI patients undergoing CMR after infarction. Between May 2003 and August 2015, 810 revascularized STEMI patients were included. CMR was performed at a median of 4 days after STEMI. Infarct size, microvascular obstruction (MVO), and left ventricular (LV) volumes and function were measured. Primary endpoint was a composite of all death and decompensated heart failure (HF).
During median follow-up of 5.5 years (range 1.0 to 13.1 years), primary endpoint occurred in 99 patients (39 deaths and 60 HF hospitalization). MVO was a strong predictor of the composite endpoint after correction for important clinical, CMR, and angiographic parameters, including age, LV systolic function, and infarct size. The independent prognostic value of MVO was confirmed in all multivariate models irrespective of whether it was included as a dichotomous (presence of MVO, hazard ratio [HR]: 1.985 to 1.995), continuous (MVO extent as % LV, HR: 1.095 to 1.097), or optimal cutoff value (MVO extent ≥2.6% of LV; HR: 3.185 to 3.199; p < 0.05 for all). MVO extent ≥2.6% of LV was a strong independent predictor of all death (HR: 2.055; 95% confidence interval: 1.076 to 3.925; p = 0.029) and HF hospitalization (HR: 5.999; 95% confidence interval: 3.251 to 11.069; p < 0.001). Finally, MVO extent ≥2.6% of LV provided incremental prognostic value over traditional outcome predictors (net reclassification improvement index: 0.16 to 0.30; p < 0.05 for all models).
Early post-infarction CMR-based MVO is a strong independent prognosticator in revascularized STEMI patients. Remarkably, MVO extent ≥2.6% of LV improved long-term risk stratification over traditional outcome predictors.
本研究旨在探讨心肌梗死后早期心脏磁共振（CMR）参数是否能为 ST 段抬高型心肌梗死（STEMI）患者提供比传统预后预测因子更长期的预后价值。
CMR 在 STEMI 患者中的长期预后意义尚未得到评估。
这是一项来自多中心注册的纵向研究，前瞻性纳入了梗死后接受 CMR 的 STEMI 患者。2003 年 5 月至 2015 年 8 月，共纳入 810 例接受再血管化治疗的 STEMI 患者。CMR 在 STEMI 后中位 4 天进行。测量梗死面积、微血管阻塞（MVO）以及左心室（LV）容积和功能。主要终点是所有死亡和失代偿性心力衰竭（HF）的复合终点。
在中位 5.5 年（范围 1.0 至 13.1 年）的随访期间，99 例患者发生了主要终点（39 例死亡和 60 例 HF 住院）。校正重要临床、CMR 和血管造影参数后，MVO 是复合终点的强烈预测因子，包括年龄、LV 收缩功能和梗死面积。MVO 的独立预后价值在所有多变量模型中均得到证实，无论其是否作为二分类（存在 MVO，风险比 [HR]：1.985 至 1.995）、连续（MVO 程度作为 LV 的%，HR：1.095 至 1.097）或最佳截断值（MVO 程度≥2.6%的 LV；HR：3.185 至 3.199；所有 p 值均<0.05）纳入。LV 中 MVO 程度≥2.6%是所有死亡（HR：2.055；95%置信区间：1.076 至 3.925；p=0.029）和 HF 住院（HR：5.999；95%置信区间：3.251 至 11.069；p<0.001）的强烈独立预测因子。最后，LV 中 MVO 程度≥2.6%提供了比传统预后预测因子更高的增量预后价值（净重新分类改善指数：0.16 至 0.30；所有模型的 p 值均<0.05）。
再血管化治疗的 STEMI 患者梗死后早期 CMR 上的 MVO 是一个强大的独立预后指标。值得注意的是，LV 中 MVO 程度≥2.6%改善了传统预后预测因子的长期风险分层。
