Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study

Gianluca Pontone; Andrea I Guaricci; Daniele Andreini; Giovanni Ferro; Marco Guglielmo; Andrea Baggiano; Laura Fusini; Giuseppe Muscogiuri; Valentina Lorenzoni; Saima Mushtaq; Edoardo Conte; Andrea Annoni; Alberto Formenti; Maria Elisabetta Mancini; Patrizia Carità; Massimo Verdecchia; Silvia Pica; Fabio Fazzari; Nicola Cosentino; Giancarlo Marenzi; Mark G Rabbat; Piergiuseppe Agostoni; Antonio L Bartorelli; Mauro Pepi; Pier Giorgio Masci

doi:10.1161/CIRCIMAGING.117.006428

Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study

Circ Cardiovasc Imaging. 2017 Nov;10(11):e006428. doi: 10.1161/CIRCIMAGING.117.006428.

Authors

Gianluca Pontone¹, Andrea I Guaricci², Daniele Andreini², Giovanni Ferro², Marco Guglielmo², Andrea Baggiano², Laura Fusini², Giuseppe Muscogiuri², Valentina Lorenzoni², Saima Mushtaq², Edoardo Conte², Andrea Annoni², Alberto Formenti², Maria Elisabetta Mancini², Patrizia Carità², Massimo Verdecchia², Silvia Pica², Fabio Fazzari², Nicola Cosentino², Giancarlo Marenzi², Mark G Rabbat², Piergiuseppe Agostoni², Antonio L Bartorelli², Mauro Pepi², Pier Giorgio Masci²

Affiliations

¹ From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.). gianluca.pontone@ccfm.it.
² From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.).

PMID: 29146587
DOI: 10.1161/CIRCIMAGING.117.006428

Abstract

Background: Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement.

Methods and results: Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61.4±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score (P<0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE (P<0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311-2.658]; P<0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement.

Conclusions: CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiography-LVEF and may impact the management of patients with ST-segment-elevation myocardial infarction.

Keywords: ST-segment–elevation myocardial infarction; humans; magnetic resonance; prognosis.

Publication types

Comparative Study

MeSH terms

Aged
Chi-Square Distribution
Coronary Angiography
Coronary Circulation
Echocardiography
Female
Hemorrhage / diagnostic imaging
Humans
Magnetic Resonance Imaging, Cine*
Male
Microcirculation
Middle Aged
Multivariate Analysis
Percutaneous Coronary Intervention
Predictive Value of Tests
Proportional Hazards Models
Risk Factors
ST Elevation Myocardial Infarction / diagnostic imaging*
ST Elevation Myocardial Infarction / physiopathology
ST Elevation Myocardial Infarction / therapy
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left