Zhang Shiru, Ma Quanmei, Jiao Yundi, Wu Jiake, Yu Tongtong, Hou Yang, Sun Zhijun, Zheng Liqiang, Sun Zhaoqing
Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Cardiovasc Med. 2022 Aug 16;9:933733. doi: 10.3389/fcvm.2022.933733. eCollection 2022.
Cardiovascular magnetic resonance (CMR) is a powerful tool to quantify the myocardial area at risk (AAR) and infarct size (IS), and evaluate the extent of myocardial salvage in acute ST-segment elevation myocardial infarction (STEMI). This study aimed to assess the prognostic value of myocardial salvage index (MSI) assessed by CMR in reperfused STEMI and investigate whether MSI could improve the predictive efficacy of the Global Registry of Acute Coronary Events (GRACE) risk score.
About 104 consecutive patients who were hospitalized with first-time STEMI and received reperfusion therapy were prospectively enrolled. The primary endpoint was the incident of major adverse cardiovascular event (MACE) including all-cause mortality, non-fatal myocardial reinfarction and congestive heart failure within 36 months after the index event. Cox regression analysis was used to evaluate the prognostic association of MSI with MACE risk. About 21 (20.2%) patients developed MACE during the 3-year follow-up period, and patients with MSI < median had a higher incidence of MACE than those with MSI ≥ median [16 (30.8%) vs. 5 (9.6%), = 0.007]. After adjusting all the parameters associated with MACE in univariate Cox analysis, MSI assessed by CMR remained independently significant as a predictor of MACE in multivariate Cox analysis (hazard ratio 0.963, 95% CI: 0.943-0.983; < 0.001). Adding MSI to the GRACE risk score significantly increased the prognostic accuracy of the GRACE risk score (area under the curve: 0.833 vs. 0.773; = 0.044), with a net reclassification improvement of 0.635 ( = 0.009) and an integrated discrimination improvement of 0.101 ( = 0.002).
This study confirmed that MSI assessed by CMR had a good long-term prognostic value in reperfused STEMI and improve the prognostic performance of the GRACE risk score.
心血管磁共振成像（CMR）是一种用于量化急性ST段抬高型心肌梗死（STEMI）患者心肌梗死危险区面积（AAR）和梗死面积（IS），并评估心肌挽救程度的有力工具。本研究旨在评估CMR评估的心肌挽救指数（MSI）在再灌注STEMI患者中的预后价值，并探究MSI是否能提高全球急性冠状动脉事件注册研究（GRACE）风险评分的预测效能。
前瞻性纳入约104例首次因STEMI住院并接受再灌注治疗的连续患者。主要终点为首次事件后36个月内发生的主要不良心血管事件（MACE），包括全因死亡、非致命性心肌再梗死和充血性心力衰竭。采用Cox回归分析评估MSI与MACE风险的预后相关性。在3年随访期内，约21例（20.2%）患者发生MACE，MSI<中位数的患者MACE发生率高于MSI≥中位数的患者[16例（30.8%）对5例（9.6%），P=0.007]。在单因素Cox分析中对所有与MACE相关的参数进行校正后，CMR评估的MSI在多因素Cox分析中作为MACE的预测指标仍具有独立显著性（风险比0.963，95%CI：0.943-0.983；P<0.001）。将MSI加入GRACE风险评分显著提高了GRACE风险评分的预后准确性（曲线下面积：0.833对0.773；P=0.044），净重新分类改善为0.635（P=0.009），综合判别改善为0.101（P=0.002）。
本研究证实，CMR评估的MSI在再灌注STEMI患者中具有良好的长期预后价值，并能提高GRACE风险评分的预后性能。
