TY - JOUR
T1 - Determinants and prognostic value of cardiac magnetic resonance imaging-derived infarct characteristics in non-ST-elevation myocardial infarction
AU - Feistritzer, Hans Josef
AU - Nanos, Michael
AU - Eitel, Ingo
AU - Jobs, Alexander
AU - De Waha-Thiele, Suzanne
AU - Meyer-Saraei, Roza
AU - Freund, Anne
AU - Stiermaier, Thomas
AU - Abdel-Wahab, Mohamed
AU - Lurz, Philipp
AU - Reinstadler, Sebastian J.
AU - Reindl, Martin
AU - Klug, Gert
AU - Metzler, Bernhard
AU - Desch, Steffen
AU - Thiele, Holger
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: [email protected].
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Aims: The prognostic significance of cardiac magnetic resonance (CMR)-derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients. We aimed to investigate determinants and the long-term prognostic impact of CMR imaging-derived infarct characteristics in patients with NSTEMI. Methods and results: Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction were assessed using CMR imaging in 284 NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centres. CMR imaging was performed 3 [interquartile range (IQR) 2-4] days after admission. The primary clinical endpoint was defined as major adverse cardiac events during median follow-up of 4.4 (IQR 3.6-4.9) years. Median IS was 7.2% (IQR 2.2-13.7) of left ventricular (LV) myocardial mass (%LV) and MSI was 65.7 (IQR 39.3-84.9). Age (P ≤ 0.003), heart rate (P ≤ 0.02), the number of diseased coronary arteries (P ≤ 0.01), and Thrombolysis In Myocardial Infarction (TIMI) flow grade before PCI (P < 0.001) were independent predictors of IS and MSI. The primary endpoint occurred in 64 (22.5%) patients. CMR-derived infarct characteristics had no additional prognostic value beyond LV ejection fraction in multivariable analysis. Conclusion: In this prospective, multicentre NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries, and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics over and above LV ejection fraction. Clinicaltrials.gov: NCT03516578.
AB - Aims: The prognostic significance of cardiac magnetic resonance (CMR)-derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients. We aimed to investigate determinants and the long-term prognostic impact of CMR imaging-derived infarct characteristics in patients with NSTEMI. Methods and results: Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction were assessed using CMR imaging in 284 NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centres. CMR imaging was performed 3 [interquartile range (IQR) 2-4] days after admission. The primary clinical endpoint was defined as major adverse cardiac events during median follow-up of 4.4 (IQR 3.6-4.9) years. Median IS was 7.2% (IQR 2.2-13.7) of left ventricular (LV) myocardial mass (%LV) and MSI was 65.7 (IQR 39.3-84.9). Age (P ≤ 0.003), heart rate (P ≤ 0.02), the number of diseased coronary arteries (P ≤ 0.01), and Thrombolysis In Myocardial Infarction (TIMI) flow grade before PCI (P < 0.001) were independent predictors of IS and MSI. The primary endpoint occurred in 64 (22.5%) patients. CMR-derived infarct characteristics had no additional prognostic value beyond LV ejection fraction in multivariable analysis. Conclusion: In this prospective, multicentre NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries, and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics over and above LV ejection fraction. Clinicaltrials.gov: NCT03516578.
UR - http://www.scopus.com/inward/record.url?scp=85077107611&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/ee09a0f1-78f3-3649-956d-15e43fe7a8c6/
U2 - 10.1093/ehjci/jez165
DO - 10.1093/ehjci/jez165
M3 - Journal articles
C2 - 31518417
AN - SCOPUS:85077107611
SN - 2047-2404
VL - 21
SP - 67
EP - 76
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 1
ER -
