Stiermaier Thomas, Jobs Alexander, de Waha Suzanne, Fuernau Georg, Pöss Janine, Desch Steffen, Thiele Holger, Eitel Ingo
From the University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany.
Circ Cardiovasc Imaging. 2017 Nov;10(11). doi: 10.1161/CIRCIMAGING.117.006774.
Cardiac magnetic resonance (CMR) demonstrated great potential for the prediction of major adverse cardiac events (MACE) in ST-segment-elevation myocardial infarction. The aim of this study was to develop and validate a CMR-based risk score for ST-segment-elevation myocardial infarction patients.
The scoring model was developed and validated on ST-segment-elevation myocardial infarction cohorts from 2 independent randomized controlled trials (n=738 and n=458 patients, respectively) and included left ventricular (LV) ejection fraction, infarct size, and microvascular obstruction. Primary end point was the 12-month MACE rate consisting of death, reinfarction, and new congestive heart failure. In the derivation cohort, LV ejection fraction ≤47%, infarct size ≥19%LV, and microvascular obstruction ≥1.4%LV were identified as the best cutoff values for MACE prediction. According to the hazard ratios in multivariable regression analysis, the CMR risk score was created by attributing 1 point for LV ejection fraction ≤47%, 1 point for infarct size ≥19%LV, and 2 points for microvascular obstruction ≥1.4%LV. In the validation cohort, the score showed a good prediction of MACE (area under the curve: 0.76). Stratification into a low (0/1 point) and high-risk group (≥2 points) resulted in significantly higher MACE rates in high-risk patients (9.0% versus 2.2%; =0.001). Inclusion of the CMR score in addition to a model of clinical risk factors led to a significant increase of C statistics from 0.74 to 0.83 (=0.037), a net reclassification improvement of 0.18 (=0.009), and an integrated discriminative improvement of 0.04 (=0.010).
Our approach integrates the prognostic information of CMR imaging into a simple risk score that showed incremental prognostic value over clinical risk factors in ST-segment-elevation myocardial infarction patients.
URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00712101 and NCT02158468.
心脏磁共振成像（CMR）在预测ST段抬高型心肌梗死的主要不良心脏事件（MACE）方面显示出巨大潜力。本研究的目的是为ST段抬高型心肌梗死患者开发并验证基于CMR的风险评分。
该评分模型在2项独立随机对照试验的ST段抬高型心肌梗死队列中进行开发和验证（分别为738例和458例患者），纳入左心室（LV）射血分数、梗死面积和微血管阻塞情况。主要终点是12个月的MACE发生率，包括死亡、再梗死和新发充血性心力衰竭。在推导队列中，LV射血分数≤47%、梗死面积≥19%LV和微血管阻塞≥1.4%LV被确定为预测MACE的最佳临界值。根据多变量回归分析中的风险比，通过对LV射血分数≤47%赋予1分、梗死面积≥19%LV赋予1分、微血管阻塞≥1.4%LV赋予2分来创建CMR风险评分。在验证队列中，该评分对MACE有良好的预测能力（曲线下面积：0.76）。分为低风险（0/1分）和高风险组（≥2分）后，高风险患者的MACE发生率显著更高（9.0%对2.2%；P = 0.001）。除临床危险因素模型外纳入CMR评分导致C统计量从0.74显著增加到0.83（P = 0.037），净重新分类改善为0.18（P = 0.009），综合判别改善为0.04（P = 0.010）。
我们的方法将CMR成像的预后信息整合到一个简单的风险评分中，该评分在ST段抬高型心肌梗死患者中显示出比临床危险因素更高的预后价值。
网址：http://www.clinicaltrials.gov。唯一标识符：NCT00712101和NCT02158468。
