用于再灌注ST段抬高型心肌梗死长期风险分层的非对比CMR风险评分

A Noncontrast CMR Risk Score for Long-Term Risk Stratification in Reperfused ST-Segment Elevation Myocardial Infarction.

作者信息

Bulluck Heerajnarain, Carberry Jaclyn, Carrick David, McCartney Peter J, Maznyczka Annette M, Greenwood John P, Maredia Neil, Chowdhary Saqib, Gershlick Anthony H, Appleby Clare, Cotton James M, Wragg Andrew, Curzen Nick, McEntegart Margaret, Petrie Mark C, Eteiba Hany, Watkins Stuart, Lindsay Mitchell, Mahrous Ahmed, Oldroyd Keith G, Berry Colin

机构信息

British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland; University of East Anglia, Norwich, United Kingdom; Leeds University and Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.

British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland.

出版信息

JACC Cardiovasc Imaging. 2022 Mar;15(3):431-440. doi: 10.1016/j.jcmg.2021.08.006. Epub 2022 Jan 12.

DOI:10.1016/j.jcmg.2021.08.006

PMID:35272808

Abstract

OBJECTIVES

This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure.

BACKGROUND

A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI).

METHODS

The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score.

RESULTS

There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score.

CONCLUSIONS

This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).

摘要

目的

本研究比较了非增强心脏磁共振成像（CMR）风险评分对全因死亡、非致死性心肌梗死和新发充血性心力衰竭这一复合终点的预后价值。

背景

最近提出了一种包括左心室射血分数（LVEF）、心肌梗死（MI）面积和微血管阻塞（MVO）的心血管磁共振（CMR）风险评分，用于对ST段抬高型心肌梗死（STEMI）患者进行风险分层。

方法

将艾特尔CMR风险评分和全球急性冠状动脉事件注册（GRACE）评分作为参考（评分1：急性心肌梗死面积≥左心室19%，LVEF≤47%，MVO>左心室1.4%以及GRACE评分）。评分2中用心肌内出血（IMH）替代MVO（急性心肌梗死面积≥左心室19%，LVEF≤47%，IMH以及GRACE评分）。评分3仅包括LVEF≤45%、IMH以及GRACE评分。

结果

推导队列中有370例患者，验证队列中有234例患者。在推导队列中，这3种评分在预测1年复合终点方面表现相似且优于GRACE评分，C统计量分别为0.83、0.83、0.82和0.74。在验证队列中，评分3具有良好的区分度和校准度，对于1年复合结局，C统计量为0.87，在Hosmer-Lemeshow拟合优度检验中的P值为0.71。5年复合结局的Kaplan-Meier曲线显示，LVEF≤45%（高危）以及LVEF>45%且有IMH（中危）的患者累积事件显著高于LVEF>45%且无IMH（低危）的患者，对数秩检验：P值分别为0.02和0.03。高危组的风险比（HR）为2.3（95%置信区间：1.1 - 4.7），中危组为2.0（95%置信区间：1.0 - 3.8），在调整GRACE评分后这些结果仍然显著。

结论

这种非增强CMR风险评分的性能与既定风险评分相当，STEMI患者可分为低风险（LVEF>45%且无IMH）、中风险（LVEF>45%且有IMH）和高风险（LVEF≤45%）。（低剂量辅助替奈普酶在直接经皮冠状动脉介入治疗期间的试验[T-TIME]；NCT02257294）（ST段抬高型心肌梗死中心脏损伤的检测及意义[BHF MR-MI]；NCT02072850）