Prognostic relevance of peri-infarct zone measured by cardiovascular magnetic resonance in patients with ST-segment elevation myocardial infarction
| Autor: | Sebastian J. Reinstadler, Georg Fuernau, Hans-Josef Feistritzer, Steffen Desch, Holger Thiele, Ingo Eitel, Suzanne de Waha-Thiele, Thomas Stiermaier, Philipp-Johannes Jensch |
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| Rok vydání: | 2022 |
| Předmět: |
Male
medicine.medical_specialty Magnetic Resonance Spectroscopy Population Myocardial Infarction Magnetic Resonance Imaging Cine Infarction Ventricular Function Left Percutaneous Coronary Intervention Interquartile range Internal medicine medicine Humans Prospective Studies cardiovascular diseases Myocardial infarction education education.field_of_study Framingham Risk Score Ejection fraction business.industry Stroke Volume Prognosis medicine.disease Magnetic Resonance Imaging Cardiology ST Elevation Myocardial Infarction Cardiology and Cardiovascular Medicine business Mace TIMI |
| Zdroj: | International Journal of Cardiology. 347:83-88 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2021.11.017 |
| Popis: | Cardiac magnetic resonance (CMR) imaging provides valuable prognostic information in patients with ST-elevation myocardial infarction (STEMI). The peri-infarct zone (PIZ) is a potential marker for post-infarction risk stratification. The aim of this study was to assess the prognostic impact of PIZ in a large multicenter STEMI-trial.The study population consisted of 704 consecutive patients undergoing CMR within 10 days after STEMI to assess established parameters of myocardial injury and additionally the extent of PIZ. The primary clinical endpoint was major adverse cardiac events (MACE) consisting of death, re-infarction and new congestive heart failure within 1 year after infarction.The median heterogeneous PIZ-volume in the overall population was 14 ml (interquartile range [IQR] 7 to 24 ml). Male sex, infarct size, and left ventricular ejection fraction were identified as independent predictors of larger PIZ alterations. Patients with MACE had a significantly larger PIZ volume compared to patients without adverse events (21 ml [IQR 12 to 35 ml] versus 14 ml [IQR 7 to 23 ml]; p = 0.001). In stepwise multivariable Cox regression analysis, PIZ median (14 ml) emerged as an independent predictor of MACE (hazard ratio [HR] 2.84; 95% confidence interval [CI] 1.34 to 6.00; p = 0.006) in addition to the Thrombolysis In Myocardial Infarction (TIMI) risk score (HR 1.53; 95% CI 1.19 to 1.53; p 0.001). Addition of PIZ to a CMR risk model comprising LVEF, infarct size and microvascular obstruction resulted in net reclassification improvement of 0.46 (0.19-0.73, p 0.001).In this currently largest prospective, multicenter CMR study assessing PIZ, the extent of PIZ emerged as an independent predictor of MACE and a potential novel marker for optimized risk stratification in STEMI patients. ClinicalTrials.gov: NCT00712101. |
| Databáze: | OpenAIRE |
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