Key result
Smaller infarct size and higher myocardial salvage index predict lower 10-year death or HF hospitalization post-STEMI.
Why the study?
The study aimed to investigate the importance of infarct size, microvascular obstruction, and myocardial salvage index on 10-year outcomes in patients with STEMI.
Do acute and 3-month CMR endpoints predict 10-year all-cause mortality or heart failure hospitalization in patients with STEMI?
Do acute and 3-month CMR endpoints predict 10-year all-cause mortality or heart failure hospitalization in patients with STEMI?
CMR-derived infarct size, myocardial salvage index, LVEF, and transmurality measured acutely and at 3 months independently predict 10-year mortality and heart failure hospitalization in STEMI patients.
Supports CMR endpoints for long-term risk stratification post-STEMI; extends prior short-term findings while leaving clinical adoption open.
Aims The study aimed to investigate the importance of infarct size (IS), microvascular obstruction (MVO), and myocardial salvage index (MSI) on the 10-year outcome in patients with ST-segment elevation myocardial infarction (STEMI). Methods and Results Patients with STEMI had cardiac magnetic resonance (CMR) performed during admission and after three months to assess acute and three-month IS, MSI, left ventricular ejection fraction (LVEF), MVO and transmurality. Adjusted Cox regression models were used to investigate the association between CMR endpoints and all-cause mortality or hospitalization for heart failure 10 years after STEMI. A total of 811 patients had either acute or follow-up CMR performed. During median follow-up of 10.9 years, 173 (21%) patients died or were hospitalized for heart failure. Acute IS (adjusted hazard ratio (HR): 1.02; 95%-confidence interval (CI): 1.01-1.04; p=0.005), three-month IS (adjusted HR: 1.04; 95%-CI: 1.02-1.06; p<0.001), acute MSI (adjusted HR: 0.99; 95%-CI: 0.98-1.00; p=0.007), three-month MSI (adjusted HR: 0.99; 95%-CI: 0.98-1.00; p=0.004), acute LVEF (adjusted HR: 0.97; 95%-CI: 0.95-0.99; p=0.001), three-month LVEF (adjusted HR: 0.95; 95%-CI: 0.93-0.97; p<0.001), acute transmurality (adjusted HR: 1.01; 95%-CI: 1.00-1.02; p=0.024), and three-month transmurality (adjusted HR: 1.01; 95%-CI: 1.00-1.02; p=0.003) were all significant predictors of the composite outcome. MVO was not associated with the composite outcome (adjusted HR: 1.04; 95%-CI: 0.98-1.09; p=0.20). Conclusion Smaller IS, smaller transmurality, higher MSI, and higher LVEF measured acutely and three months after STEMI were independently associated with lower all-cause mortality and/or hospitalization for heart failure within 10 years after STEMI, whereas MVO was not. Clinical trial registration: Registered with ClinicalTrials.gov (identifiers: NCT01435408 and NCT01960933)
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ELEZI et al. (2026) studied this question. Smaller infarct size and higher myocardial salvage index independently predicted lower all-cause mortality or hospitalization for heart failure over 10 years post-STEMI (HR < 1).
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