Key result
Every 1% increase in the myocardial salvage index measured by MRI was associated with an absolute decrease of 1.7% (95% CI 1.6-1.9) in the incidence of major cardiac events after STEMI.
Why the study?
Risk stratification is recommended after STEMI, but measuring therapy efficiency with MRI has not been widely adopted despite being proposed as part of risk assessment.
Does the myocardial salvage index measured by MRI provide prognostic information on the risk of major cardiac events in patients after ST-segment elevation myocardial infarction?
Meta-Analysis (n=2,697)
Does the myocardial salvage index measured by MRI provide prognostic information on the risk of major cardiac events in patients after ST-segment elevation myocardial infarction?
Absolute Risk Reduction: 1.7 (95% CI 1.6–1.9)
Absolute Risk Reduction: 1.7%
The myocardial salvage index measured by MRI after STEMI provides significant prognostic information, with higher salvage correlating with a reduced risk of major cardiac events.
May refine post-STEMI risk stratification via MRI; leaves open incremental value over standard predictors.
In all patients with ST-segment elevation myocardial infarction, risk stratification should be performed before discharge. The measurement of therapy efficiency with magnetic resonance imaging has been proposed as part of the risk assessment, but it has not been adopted widely. This meta-analysis was conducted to summarize published data on the prognostic value of the proportion of salvaged myocardium inside previously ischemic myocardium (myocardial salvage index) measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction. Random and mixed effects models were used for analyzing the data of 10 studies with 2,697 patients. The pooled myocardial salvage index, calculated as the proportion of non-necrotic myocardium inside edematous myocardium measured by T2-weighted and T1-weighted late gadolinium enhancement MRI, was 43.0% (95% confidence interval: 37.4, 48.6). The pooled length of follow-up was 12.3 months (95% confidence interval: 7.0, 17.6). The pooled incidence of major cardiac events during follow-up, defined as cardiac death, nonfatal myocardial infarction, or admission for heart failure, was 10.6% (95% confidence interval: 5.7, 15.5). The applied mixed effects model showed an absolute decrease of 1.7% in the incidence of major cardiac events during follow-up (95% confidence interval: 1.6, 1.9) with every 1% of increase in the myocardial salvage index. The heterogeneity between studies was considerable (τ = 21.3). Analysis of aggregated follow-up data after ST-segment elevation myocardial infarction suggests that the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging provides prognostic information on the risk of major cardiac events, but considerable heterogeneity exists between studies.
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Kendziora et al. (2020) conducted a meta-analysis in ST-segment elevation myocardial infarction (n=2,697). Myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement MRI was evaluated on Major cardiac events (cardiac death, nonfatal myocardial infarction, or admission for heart failure) (Absolute decrease of 1.7% per 1% increase, 95% CI 1.6-1.9). Every 1% increase in the myocardial salvage index measured by MRI was associated with an absolute decrease of 1.7% (95% CI 1.6-1.9) in the incidence of major cardiac events after STEMI.
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