Key result
Grade 4 MET-AMI, a composite variable of infarct size and anatomy obtained from cardiac magnetic resonance imaging, was strongly associated with an increased risk of ischemic heart disease death (HR 16.04).
Why the study?
Do infarct size and anatomical characteristics assessed by cardiac magnetic resonance imaging predict long-term mortality in patients with previous acute myocardial infarction?
Cohort (n=420)
Yes
Do infarct size and anatomical characteristics assessed by cardiac magnetic resonance imaging predict long-term mortality in patients with previous acute myocardial infarction?
Hazard Ratio: 16.04 (95% CI 2.64–97.5)
p-value: p=0.003
Anatomical data of infarction obtained from cardiac magnetic resonance imaging, particularly the combination of infarct size, extent, and transmurality, strongly predicts long-term ischemic heart disease mortality after acute myocardial infarction.
May aid post-MI risk stratification by CMR; leaves open whether imaging-guided interventions improve outcomes.
BACKGROUND: Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. OBJECTIVE: To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. METHODS: A total of 1959 reports of "infarct size" were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors - left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named "MET-AMI". The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. RESULTS: The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). CONCLUSION: The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.
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Petriz et al. (2014) conducted a cohort in Acute Myocardial Infarction (n=420). Grade 4 MET-AMI (composite of infarct size, transmurality, and extent on CMRI) vs. Grade 1 MET-AMI (no abnormalities) was evaluated on Ischemic heart disease mortality (HR 16.04, 95% CI 2.64-97.5, p=0.003). Grade 4 MET-AMI, a composite variable of infarct size and anatomy obtained from cardiac magnetic resonance imaging, was strongly associated with an increased risk of ischemic heart disease death (HR 16.04).
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