Optimized Prognosis Assessment in ST-Segment-Elevation Myocardial Infarction Using a Cardiac Magnetic Resonance Imaging Risk Score

Circ Cardiovasc Imaging. 2017 Nov;10(11):e006774. doi: 10.1161/CIRCIMAGING.117.006774.

Abstract

Background: Cardiac magnetic resonance (CMR) demonstrated great potential for the prediction of major adverse cardiac events (MACE) in ST-segment-elevation myocardial infarction. The aim of this study was to develop and validate a CMR-based risk score for ST-segment-elevation myocardial infarction patients.

Methods and results: The scoring model was developed and validated on ST-segment-elevation myocardial infarction cohorts from 2 independent randomized controlled trials (n=738 and n=458 patients, respectively) and included left ventricular (LV) ejection fraction, infarct size, and microvascular obstruction. Primary end point was the 12-month MACE rate consisting of death, reinfarction, and new congestive heart failure. In the derivation cohort, LV ejection fraction ≤47%, infarct size ≥19%LV, and microvascular obstruction ≥1.4%LV were identified as the best cutoff values for MACE prediction. According to the hazard ratios in multivariable regression analysis, the CMR risk score was created by attributing 1 point for LV ejection fraction ≤47%, 1 point for infarct size ≥19%LV, and 2 points for microvascular obstruction ≥1.4%LV. In the validation cohort, the score showed a good prediction of MACE (area under the curve: 0.76). Stratification into a low (0/1 point) and high-risk group (≥2 points) resulted in significantly higher MACE rates in high-risk patients (9.0% versus 2.2%; P=0.001). Inclusion of the CMR score in addition to a model of clinical risk factors led to a significant increase of C statistics from 0.74 to 0.83 (P=0.037), a net reclassification improvement of 0.18 (P=0.009), and an integrated discriminative improvement of 0.04 (P=0.010).

Conclusions: Our approach integrates the prognostic information of CMR imaging into a simple risk score that showed incremental prognostic value over clinical risk factors in ST-segment-elevation myocardial infarction patients.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00712101 and NCT02158468.

Keywords: heart; heart failure; infarction; prognosis; risk factors.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Coronary Circulation
  • Disease Progression
  • Female
  • Heart / diagnostic imaging*
  • Heart / physiopathology
  • Heart Failure / etiology
  • Humans
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging*
  • Male
  • Microcirculation
  • Middle Aged
  • Multicenter Studies as Topic
  • Multivariate Analysis
  • Myocardium / pathology
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / mortality
  • Predictive Value of Tests
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • ST Elevation Myocardial Infarction / complications
  • ST Elevation Myocardial Infarction / diagnostic imaging*
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy
  • Stroke Volume
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left

Associated data

  • ClinicalTrials.gov/NCT00712101
  • ClinicalTrials.gov/NCT02158468