Key result
Adding CMR to baseline echo models improves major cardiovascular events prediction in older STEMI patients.
Why the study?
Older patients with STEMI represent a very high-risk population, but data on the prognostic value of early CMR in this scenario are scarce.
Does early cardiac magnetic resonance improve prognostic prediction of major adverse cardiac events in older patients (>70 years) with STEMI treated with percutaneous intervention?
Cohort (n=247)
Yes
Does early cardiac magnetic resonance improve prognostic prediction of major adverse cardiac events in older patients (>70 years) with STEMI treated with percutaneous intervention?
Early cardiac magnetic resonance provides valuable prognostic information that significantly improves the prediction of major adverse cardiac events in older patients with STEMI.
Answers are grounded in this paper and cite their sources.
May aid risk stratification in older STEMI patients; leaves open need for prospective outcome trials.
BACKGROUND: older patients with ST-segment elevation myocardial infarction (STEMI) represent a very high-risk population. Data on the prognostic value of cardiac magnetic resonance (CMR) in this scenario are scarce. METHODS: the registry comprised 247 STEMI patients over 70 years of age treated with percutaneous intervention and included in a multicenter registry. Baseline characteristics, echocardiographic parameters and CMR-derived left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments) were prospectively collected. The additional prognostic power of CMR was assessed using adjusted C-statistic, net reclassification index (NRI) and integrated discrimination improvement index (IDI). RESULTS: during a 4.8-year mean follow-up, the number of first major adverse cardiac events (MACE) was 66 (26.7%): 27 all-cause deaths and 39 re-admissions for acute heart failure. Predictors of MACE were GRACE score (HR 1.03 [1.02-1.04], P < 0.001), CMR-LVEF (HR 0.97 [0.95-0.99] per percent increase, P = 0.006) and MVO (HR 1.24 [1.09-1.4] per segment, P = 0.001). Adding CMR data significantly improved MACE prediction compared to the model with baseline and echocardiographic characteristics (C-statistic 0.759 [0.694-0.824] vs. 0.685 [0.613-0.756], NRI = 0.6, IDI = 0.08, P < 0.001). The best cut-offs for independent variables were GRACE score > 155, LVEF < 40% and MVO ≥ 2 segments. A simple score (0, 1, 2, 3) based on the number of altered factors accurately predicted the MACE per 100 person-years: 0.78, 5.53, 11.51 and 78.79, respectively (P < 0.001). CONCLUSIONS: CMR data contribute valuable prognostic information in older patients submitted to undergo CMR soon after STEMI. The Older-STEMI-CMR score should be externally validated.
No takes yet. Share an insight, caveat, or question.
Gabaldon-Perez et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=247). Cardiac magnetic resonance (CMR) vs. Baseline and echocardiographic characteristics model was evaluated on Major adverse cardiac events (MACE) (C-statistic 0.759, 95% CI 0.694-0.824, p=<0.001). Adding cardiac magnetic resonance data to baseline and echocardiographic models improved the prediction of major adverse cardiac events in older STEMI patients.
Synapse has enriched 10 related papers. Consider them for comparative context: