使用心脏磁共振成像风险评分对ST段抬高型心肌梗死进行优化的预后评估

Optimized Prognosis Assessment in ST-Segment-Elevation Myocardial Infarction Using a Cardiac Magnetic Resonance Imaging Risk Score.

作者信息

Stiermaier Thomas, Jobs Alexander, de Waha Suzanne, Fuernau Georg, Pöss Janine, Desch Steffen, Thiele Holger, Eitel Ingo

机构信息

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.

出版信息

Circ Cardiovasc Imaging. 2017 Nov;10(11). doi: 10.1161/CIRCIMAGING.117.006774.

DOI:10.1161/CIRCIMAGING.117.006774

PMID:29122844

Abstract

BACKGROUND

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.

METHODS AND RESULTS

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).

CONCLUSIONS

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.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00712101 and NCT02158468.

摘要

背景

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。

方法与结果

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）。