Adding CMR-derived microvascular obstruction and global longitudinal strain to clinical markers improved MACE prediction in STEMI patients with preserved LVEF (AUC 0.76 vs 0.65; P=0.02).
Cohort (n=1,247)
Yes
Does the addition of CMR parameters (MVO and GLS) to clinical markers improve prognostic stratification for MACE in STEMI patients with preserved LVEF following primary PCI?
In STEMI patients with preserved LVEF after primary PCI, adding CMR-derived microvascular obstruction and global longitudinal strain to clinical risk factors significantly improves prediction of major adverse cardiovascular events.
Abstract Aims To evaluate the prognostic validity of clinical risk factors as well as infarct characterization and myocardial deformation by cardiac magnetic resonance (CMR) in ST-elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF) following primary percutaneous coronary intervention (PCI). Methods and results This multicentre, individual patient-data analysis from two large CMR trials included 1247 STEMI patients. Cardiac magnetic resonance examinations were conducted 3 interquartile range (IQR) 2–4 days after PCI. LVEF, infarct size, microvascular obstruction (MVO), and myocardial strain values were measured. Primary endpoint was defined as composite of major adverse cardiovascular events (MACE) including death, re-infarction, and congestive heart failure. A preserved LVEF (defined as LVEF ≥50%) was observed in 724 patients (=58%). In the overall cohort, 97 patients experienced a MACE event follow-up time 12 (IQR 12–13) months, and 34 MACE events occurred in the group with preserved LVEF (5% vs. 12% incidence rate in patients with LVEF 50%). TIMI risk score hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.02–1.59; P = 0.03 and female gender (HR 2.24, 95% CI 1.10–4.57; P = 0.03) emerged as independent clinical determinants of MACE in the patient group with preserved LVEF. Among CMR parameters, the presence of MVO (HR 2.39, 95% CI 1.05–5.46; P = 0.04) and reduced global longitudinal strain (GLS; HR 1.12, 95% CI 1.02–1.23; P = 0.02) independently predicted MACE in the LVEF-preserved population. The addition of MVO and GLS to the clinical prognostic markers (TIMI risk score, female gender) increased (P = 0.02) the prognostic validity AUC 0.76 (95% CI 0.73–0.79) compared to the clinical markers alone AUC 0.65 (0.62–0.69). Conclusion In contemporary treated STEMI patients showing preserved LVEF, a CMR-based risk prediction approach assessing MVO and GLS provided strong prognostic value that was incremental to clinical outcome parameters.
Reindl et al. (Mon,) conducted a cohort in ST-elevation myocardial infarction with preserved ejection fraction (n=1,247). Cardiac magnetic resonance imaging (assessing MVO and GLS) vs. Clinical prognostic markers alone (TIMI risk score, female gender) was evaluated on Composite of major adverse cardiovascular events (MACE) including death, re-infarction, and congestive heart failure. Adding CMR-derived microvascular obstruction and global longitudinal strain to clinical markers improved MACE prediction in STEMI patients with preserved LVEF (AUC 0.76 vs 0.65; P=0.02).