Author + information
- Received March 9, 2017
- Revision received May 8, 2017
- Accepted May 24, 2017
- Published online June 4, 2018.
- Rolf Symons, MDa,
- Gianluca Pontone, MD, PhDb,
- Juerg Schwitter, MDc,d,
- Marco Francone, MDe,
- Juan Fernando Iglesias, MDd,
- Andrea Barison, MDf,
- Jaroslaw Zalewski, MDg,
- Laura de Luca, MDh,
- Sophie Degrauwe, MDd,
- Piet Claus, PhDa,
- Marco Guglielmo, MDb,
- Jadwiga Nessler, MDg,
- Iacopo Carbone, MDe,
- Giovanni Ferro, MDb,
- Monika Durak, MDi,
- Paolo Magistrelli, MDb,
- Alfonso Lo Presti, MD, PhDf,
- Giovanni Donato Aquaro, MDf,
- Eric Eeckhout, MDd,
- Christian Roguelov, MDd,
- Daniele Andreini, MD, PhDb,j,
- Pierre Vogt, MDd,
- Andrea Igoren Guaricci, MDk,l,
- Saima Mushtaq, MDb,
- Valentina Lorenzoni, PhDm,
- Olivier Muller, MD, PhDd,
- Walter Desmet, MD, PhDa,
- Luciano Agati, MDh,
- Stefan Janssens, MD, PhDa,
- Jan Bogaert, MD, PhDa,∗ and
- Pier Giorgio Masci, MD, PhDc,d,∗∗ ()
- aGasthuisberg University Hospitals, Leuven, Belgium
- bCentro Cardiologico Monzino, IRCCS, Milan, Italy
- cCentre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- dCardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, Lausanne, Switzerland
- eDepartment of Radiological, Oncological, and Pathological Sciences, La Sapienza University, Rome, Italy
- fFondazione CNR-Regione Toscana “G. Monasterio,”, Pisa, Italy
- gDepartment of Coronary Disease, Jagiellonian University Medical College, Krakow, Poland
- hDepartment of Cardiovascular Sciences, La Sapienza University, Rome, Italy
- iDepartment of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- jDepartment of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
- kInstitute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital “Policlinico Consorziale” of Bari, Bari, Italy
- lDepartment of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- mInstitute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
- ↵∗Address for correspondence:
Dr. Pier Giorgio Masci, Centre for Cardiac MR & Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, Rue de Bugnon 46, BH-09-792 1011 Lausanne, Switzerland.
Objectives This study sought to investigate whether early post-infarction cardiac magnetic resonance (CMR) parameters provide additional long-term prognostic value beyond traditional outcome predictors in ST-segment elevation myocardial infarction (STEMI) patients.
Background Long-term prognostic significance of CMR in STEMI patients has not been assessed yet.
Methods This was a longitudinal study from a multicenter registry that prospectively included STEMI patients undergoing CMR after infarction. Between May 2003 and August 2015, 810 revascularized STEMI patients were included. CMR was performed at a median of 4 days after STEMI. Infarct size, microvascular obstruction (MVO), and left ventricular (LV) volumes and function were measured. Primary endpoint was a composite of all death and decompensated heart failure (HF).
Results During median follow-up of 5.5 years (range 1.0 to 13.1 years), primary endpoint occurred in 99 patients (39 deaths and 60 HF hospitalization). MVO was a strong predictor of the composite endpoint after correction for important clinical, CMR, and angiographic parameters, including age, LV systolic function, and infarct size. The independent prognostic value of MVO was confirmed in all multivariate models irrespective of whether it was included as a dichotomous (presence of MVO, hazard ratio [HR]: 1.985 to 1.995), continuous (MVO extent as % LV, HR: 1.095 to 1.097), or optimal cutoff value (MVO extent ≥2.6% of LV; HR: 3.185 to 3.199; p < 0.05 for all). MVO extent ≥2.6% of LV was a strong independent predictor of all death (HR: 2.055; 95% confidence interval: 1.076 to 3.925; p = 0.029) and HF hospitalization (HR: 5.999; 95% confidence interval: 3.251 to 11.069; p < 0.001). Finally, MVO extent ≥2.6% of LV provided incremental prognostic value over traditional outcome predictors (net reclassification improvement index: 0.16 to 0.30; p < 0.05 for all models).
Conclusions Early post-infarction CMR-based MVO is a strong independent prognosticator in revascularized STEMI patients. Remarkably, MVO extent ≥2.6% of LV improved long-term risk stratification over traditional outcome predictors.
↵∗ Drs. Bogaert and Masci contributed equally to this work and are joint senior authors.
Dr. Schwitter has received speaker fees from Bayer Healthcare Germany and Bracco Healthcare; and has served as a consultant to Medtronic Healthcare. Dr. Pontone has received speaker fees from General Electric, Bracco, Heartflow, and Medtronic. Dr. Andreini has received speaker fees from General Electric. Dr. Iglesias has received speaker fees from Biotronik AG, AstraZeneca AG, and Terumo Corp. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 9, 2017.
- Revision received May 8, 2017.
- Accepted May 24, 2017.
- 2018 American College of Cardiology Foundation