Key result
Early cardiac magnetic resonance improved the prediction of major adverse cardiac events when added to baseline and echocardiographic models.
Why the study?
Elderly patients with STEMI represent a very high-risk population, but data on the prognostic value of CMR in this setting are scarce.
Does early cardiac magnetic resonance improve the prediction of major adverse cardiac events in elderly patients after STEMI?
Cohort (n=247)
Yes
Does early cardiac magnetic resonance improve the prediction of major adverse cardiac events in elderly patients after STEMI?
Early CMR provides significant incremental prognostic value over clinical and echocardiographic parameters for predicting MACE in elderly patients following STEMI.
Answers are grounded in this paper and cite their sources.
Early CMR may enhance post-MI risk stratification beyond echocardiography; extends existing models with incremental prognostic value.
Background Elderly 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. Purpose We aim to study the prognostic value of an early (1-week) CMR in elderly patients after STEMI and to create a simple risk score including clinical and CMR variables. Methods The registry comprised 247 patients over 70 years of age discharged for a first STEMI 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, 66 (26.7%) first major adverse cardiac events (MACE) occurred (27 all-cause deaths and 39 re-admissions for acute heart failure). Higher GRACE score (HR 1.03 [1.02–1.04], p<0.001), more depressed CMR-LVEF (HR 0.97 [0.95–0.99] per increased %, p=0.006) and more extensive MVO (HR 1.24 [1.09–1.4] per segment, p=0.001) predicted MACE occurrence. The addition of 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, and 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 elderly patients submitted to undergo CMR soon after STEMI. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Instituto de Salud Carlos III and “Fondos Europeos de Desarrollo Regional FEDER” and Conselleria de Educaciόn – Generalitat Valenciana.
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Garces et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=247). Early (1-week) cardiac magnetic resonance (CMR) vs. Baseline and echocardiographic characteristics was evaluated on Major adverse cardiac events (MACE) (C-statistic 0.759, 95% CI 0.694-0.824, p=<0.001). Early cardiac magnetic resonance improved the prediction of major adverse cardiac events when added to baseline and echocardiographic models.
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