Key result
Myocardial salvage index assessed by cardiac magnetic resonance imaging was an independent predictor of major adverse cardiovascular events (HR 0.94) and added incremental prognostic value over traditional markers.
Why the study?
Does the addition of CMR parameters to traditional outcome markers improve prognostic assessment for MACE in STEMI patients reperfused by primary PCI?
Cohort (n=278)
Single-blind
No
Does the addition of CMR parameters to traditional outcome markers improve prognostic assessment for MACE in STEMI patients reperfused by primary PCI?
Answers are grounded in this paper and cite their sources.
CMR parameters, particularly myocardial salvage index, provide significant incremental prognostic value over traditional clinical and echocardiographic markers in patients with STEMI undergoing primary PCI.
BACKGROUND: This study aimed to evaluate the incremental prognostic value of infarct size, microvascular obstruction (MO), myocardial salvage index (MSI), and left ventricular ejection fraction (LV-EFCMR) assessed by cardiac magnetic resonance imaging (CMR) in comparison to traditional outcome markers in patients with ST-elevation myocardial infarction (STEMI) reperfused by primary percutaneous intervention (PCI). METHODS: STEMI patients reperfused by primary PCI (n=278) within 12 hours after symptom onset underwent CMR three days after the index event (interquartile range [IQR] two to four). Infarct size and MO were measured 15 minutes after gadolinium injection. T2-weighted and contrast-enhanced CMR were used to calculate MSI. In addition, traditional outcome markers such as ST-segment resolution, pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI)-flow, maximum level of creatine kinase-MB, TIMI-risk score, and left ventricular ejection fraction assessed by echocardiography were determined in all patients. Clinical follow-up was conducted after 19 months (IQR 10 to 27). The primary endpoint was defined as a composite of death, myocardial reinfarction, and congestive heart failure (MACE). RESULTS: In multivariable Cox regression analysis, adjusting for all traditional outcome parameters significantly associated with the primary endpoint in univariable analysis, MSI was identified as an independent predictor for the occurrence of MACE (Hazard ratio 0.94, 95% CI 0.92 to 0.96, P<0.001). Further, C-statistics comparing a model including only traditional outcome markers to a model including CMR parameters on top of traditional outcome markers revealed an incremental prognostic value of CMR parameters (0.74 versus 0.94, P<0.001). CONCLUSIONS: CMR parameters such as infarct size, MO, MSI, and LV-EFCMR add incremental prognostic value above traditional outcome markers alone in acute reperfused STEMI. TRIAL REGISTRATION: Clinicaltrials.gov NCT00463749, Clinicaltrials.gov NCT00359918.
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Waha et al. (2014) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=278). Cardiac magnetic resonance imaging (CMR) parameters (Myocardial Salvage Index) vs. Traditional outcome markers was evaluated on Composite of death, myocardial reinfarction, and congestive heart failure (MACE) (HR 0.94, 95% CI 0.92 to 0.96, p=<0.001). Myocardial salvage index assessed by cardiac magnetic resonance imaging was an independent predictor of major adverse cardiovascular events (HR 0.94) and added incremental prognostic value over traditional markers.
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