Predictors of cardiovascular magnetic resonance-derived microvascular obstruction on patient admission in STEMI
| Autor: | Cristina Gomez, Ernesto Valero, Maria P. Lopez-Lereu, Jose V. Monmeneu, Clara Bonanad, Pilar Merlos, Juan Sanchis, Fabian Chaustre, Gema Miñana, Julio Núñez, Maria J. Forteza, Oliver Husser, Àngel Llàcer, Francisco J. Chorro, Günter A.J. Riegger, Eva Rumiz, Vicente Bodi |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Myocardial Infarction Magnetic Resonance Imaging Cine Coronary Artery Disease Delayed presentation Patient Admission Predictive Value of Tests Coronary Circulation Diabetes mellitus Internal medicine Humans Medicine Prospective Studies cardiovascular diseases Myocardial infarction Prospective cohort study Aged Killip class medicine.diagnostic_test business.industry Microcirculation Magnetic resonance imaging Middle Aged medicine.disease Surgery Predictive value of tests Cardiology Female Myocardial infarction diagnosis Cardiology and Cardiovascular Medicine business human activities |
| Zdroj: | International Journal of Cardiology. 166:77-84 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2011.09.083 |
| Popis: | Early stratification of patients according to the risk for developing microvascular obstruction (MVO) after ST-segment elevation myocardial infarction (STEMI) is desirable. We aimed to identify predictors of cardiovascular magnetic resonance (CMR)-derived MVO from clinical+ECG, laboratory and angiographic parameters available on admission.Characteristics available on admission were documented in 97 STEMI patients referred for primary angioplasty. MVO was determined using contrast-enhanced CMR.MVO was present in 44 patients (45%). The C-statistic for predicting MVO was: clinical+ECG (.832), laboratory (.743), and angiographic parameters (.669). Adding laboratory to clinical+ECG information did not improve the C-statistic (.873 vs. .832, p=.2). Further addition of angiographic data (.904) improved the C-statistic of clinical+ECG (p=.04) but not of clinical+ECG and laboratory (p=.2). Independent predictors of MVO using clinical and ECG parameters were: Killip class1 (OR 15.97 95%CI [1.37-186.76], p=.03), diabetes (OR 6.15 95%CI [1.49-25.39], p=.01), age55years (OR 4.70 95%CI [1.56-14.17], p=.006), sum of ST-segment elevation10mm (OR 4.5 95%CI [1.58-12.69], p=.005) and delayed presentation3h (OR 3.80 95%CI [1.19-12.1], p=.02). A score was constructed assigning Killip class1 2 points and the remaining indexes 1 point. The incidence of MVO increased with the score: 0 point: 8.7%; 1 point: 28.1%; 2 points: 71.4%; and 3+ points: 93% (p.0001).MVO can be predicted using parameters already available on patient admission. We developed a clinical-ECG score allowing for early and reliable classification of STEMI patients according to the risk of MVO. |
| Databáze: | OpenAIRE |
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