Key result
CMR-based CCS stages predict up to ~16% 12-month MACE in post-PCI STEMI patients.
Why the study?
The baseline clinical associations and prognostic implications of the four-stage Canadian Cardiovascular Society myocardial tissue injury classification in STEMI remained to be explored.
Does the Canadian Cardiovascular Society (CCS) myocardial tissue injury classification predict MACE and mortality in STEMI patients treated by PCI?
Does the Canadian Cardiovascular Society (CCS) myocardial tissue injury classification predict MACE and mortality in STEMI patients treated by PCI?
Answers are grounded in this paper and cite their sources.
The Canadian Cardiovascular Society (CCS) classification of myocardial tissue injury using CMR effectively stratifies the 12-month risk of MACE and mortality in STEMI patients reperfused by PCI.
Background Myocardial infarction (MI) involves progressive tissue damage beyond necrosis. The recently proposed Canadian Cardiovascular Society (CCS) classification defines this damage in four stages, potentially optimizing personalized risk stratification and advancing research on cardioprotective treatments. The baseline associations and prognostic implications of this classification remain to be explored. Aim To compare clinical characteristics across CCS stages and to validate their prognostic implications in patients with ST-elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI). Methods and Results We analysed 1,109 STEMI patients included in three prospective studies. Cardiac magnetic resonance (CMR) imaging was performed 3 (interquartile range 2-5) days after MI and patients were classified as follows: stage 1 (aborted MI), stage 2 (MI with necrosis and absence of microvascular injury), stage 3 (MI with necrosis and microvascular obstruction) and stage 4 (MI with necrosis and intramyocardial haemorrhage). This analysis revealed distinct patterns of clinical presentation, biomarker profiles and cardiac function at different CCS stages. There were differences in adverse clinical event rates and mortality between CCS stages (major adverse cardiovascular event [MACE]: 0.7%, 3.4%, 3.1%, 15.7%, p<0.001 and mortality: 0.7%, 1.7%, 0.9%, 6.3%, p<0.001). The CCS stage had a moderate to good predictive value for MACE and mortality (AUC 0.74 [95% CI: 0.68-0.80], p<0.001 and AUC 0.71 [95% CI: 0.61-0.80], p<0.001) at 12 months, respectively. Conclusion This study describes clinical characteristics across CCS stages and provides insights into the prognostic implications of the different stages of tissue injury severity in a large cohort of STEMI patients reperfused by PCI. These data should inform the use of CCS stages in future trial designs.
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Lechner et al. (2025) studied this question. CCS classification stages predict 12-month MACE (0.7%-15.7%) and mortality (0.7%-6.3%) in STEMI patients post-PCI with AUCs of 0.74 and 0.71, respectively.
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