ST段抬高型心肌梗死患者的预后分层（PROSPECT）：一项心脏磁共振研究
Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study.
作者信息
Pontone Gianluca, Guaricci Andrea I, Andreini Daniele, Ferro Giovanni, Guglielmo Marco, Baggiano Andrea, Fusini Laura, Muscogiuri Giuseppe, Lorenzoni Valentina, Mushtaq Saima, Conte Edoardo, Annoni Andrea, Formenti Alberto, Mancini Maria Elisabetta, Carità Patrizia, Verdecchia Massimo, Pica Silvia, Fazzari Fabio, Cosentino Nicola, Marenzi Giancarlo, Rabbat Mark G, Agostoni Piergiuseppe, Bartorelli Antonio L, Pepi Mauro, Masci Pier Giorgio
机构信息
From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.).
出版信息
Circ Cardiovasc Imaging. 2017 Nov;10(11). doi: 10.1161/CIRCIMAGING.117.006428.
BACKGROUND
Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement.
METHODS AND RESULTS
Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61.4±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score (<0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE (<0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311-2.658]; <0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement.
CONCLUSIONS
CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiography-LVEF and may impact the management of patients with ST-segment-elevation myocardial infarction.
背景
心脏磁共振成像（CMR）是评估ST段抬高型心肌梗死患者左心室射血分数（LVEF）、心肌挽救指数、微血管阻塞及心肌出血的有力工具。我们通过急性冠状动脉事件全球注册（GRACE）评分和经胸超声心动图LVEF测量，评估了CMR评分相对于标准预后分层的额外预后价值。
方法与结果
连续209例ST段抬高型心肌梗死患者（年龄61.4±11.4岁；男性162例）在成功进行直接经皮冠状动脉介入治疗后接受了经胸超声心动图和CMR检查。在平均2.5±1.2年的随访中评估主要不良心脏事件（MACE）。与无MACE的患者相比，24例（12%）发生MACE的患者在基线时GRACE风险评分更高（<0.01），经胸超声心动图和CMR测得的LVEF更低，心肌挽救指数更低，每位患者的心肌出血和微血管阻塞患病率及数量更高（<0.01）。经胸超声心动图-LVEF、CMR-LVEF、心肌挽救指数和微血管阻塞预测MACE的最佳截断值分别为左心室质量的46.7%、37.5%、0.4和2.6%。据此，计算了一个包括以下4个变量（CMR-LVEF、心肌挽救指数、微血管阻塞和心肌出血）的加权CMR评分，最高为17分，并纳入多变量分析，结果显示与GRACE评分和经胸超声心动图-LVEF测量相比，只有CMR评分（每标准差增加的风险比为1.867 [1.311-2.658]；<0.001）与MACE独立相关，且净重新分类改善最高。
结论
与GRACE评分和经胸超声心动图-LVEF相比，CMR评分可提供额外的预后分层，可能会影响ST段抬高型心肌梗死患者的管理。
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