Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction

[EN] Background: Cardiac magnetic resonance (CMR) performed early after ST-segment elevation myocardial infarction (STEMI) can improve major adverse cardiac event (MACE) risk prediction. We aimed to create a simple clinical-CMR risk score for early MACE risk stratification in STEMI patients. Methods: We performed a multicenter prospective registry of reperfused STEMI patients (n = 1118) in whom early (1-week) CMR-derived left ventricular ejection fraction (LVEF), infarct size and microvascular obstruction (MVO) were quantified. MACE was defined as a combined clinical endpoint of cardiovascular (CV) death, nonfatal myocardial infarction (NF-MI) or re-admission for acute decompensated heart failure (HF). Results: During a median follow-up of 5.52 [2.63-7.44] years, 216 first MACE (58 CV deaths, 71 NF-MI and 87 HF) were registered. Mean age was 59.3 +/- 12.3 years and most patients (82.8%) were male. Based on the four variables independently associated with MACE, we computed an 8-point risk score: time to reperfusion >4.15 h (1 point), GRACE risk score > 155 (3 points), CMR-LVEF 1.5 segments (1 point). This score permitted MACE risk stratification: MACE per 100 person-years was 1.96 in the low-risk category (0-2 points), 5.44 in the intermediate-risk category (3-5 points), and 19.7 in the high-risk category (6-8 points): p 4.15 h and GRACE risk score > 155) and CMR (LVEF 1.5 segments) variables allows for simple and straightforward MACE risk stratification early after STEMI. External validation should confirm the applicability of the risk score.This work was supported by the Instituto de Salud Carlos III and cofunded by Fondo Europeo de Desarrollo Regional (FEDER) (grants PI20/00637 and CIBERCV16/11/00486), "Marató TV3" [grant number 20153030-31-32], the Catalonian Society of Cardiology 2015, La Caixa Foundation [HR17-00527], and by Sociedad Española de Cardiología (grant SEC/FECINV-CLI 21/024). D.M. acknowledges financial support from the Conselleria d'Educació, Investigació, Cultura i Esport, Generalitat Valenciana (grants AEST/ 2019/037 and AEST/2020/029). J. G. acknowledges financial support from the Agencia Estatal de Investigación (grant FJC2020-043981-I / AEI/10.13039/501100011033).Marcos-Garcés, V.; Perez, N.; Gavara-Doñate, J.; Lopez-Lereu, MP.; Monmeneu, JV.; Rios-Navarro, C.; De Dios, E.... (2022). Risk score for early risk prediction by cardiac magnetic resonance after acute myocardial infarction. International Journal of Cardiology. 349:150-154. https://doi.org/10.1016/j.ijcard.2021.11.05015015434

Prognostic value of cardiac magnetic resonance early after ST-segment elevation myocardial infarction in older patients

[EN] Background older patients with ST-segment elevation myocardial infarction (STEMI) represent a very high-risk population. Data on the prognostic value of cardiac magnetic resonance (CMR) in this scenario are scarce. Methods the registry comprised 247 STEMI patients over 70 years of age treated with percutaneous intervention and included in a multicenter registry. Baseline characteristics, echocardiographic parameters and CMR-derived left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments) were prospectively collected. The additional prognostic power of CMR was assessed using adjusted C-statistic, net reclassification index (NRI) and integrated discrimination improvement index (IDI). Results during a 4.8-year mean follow-up, the number of first major adverse cardiac events (MACE) was 66 (26.7%): 27 all-cause deaths and 39 re-admissions for acute heart failure. Predictors of MACE were GRACE score (HR 1.03 [1.02-1.04], P 155, LVEF = 2 segments. A simple score (0, 1, 2, 3) based on the number of altered factors accurately predicted the MACE per 100 person-years: 0.78, 5.53, 11.51 and 78.79, respectively (P < 0.001). Conclusions CMR data contribute valuable prognostic information in older patients submitted to undergo CMR soon after STEMI. The Older-STEMI-CMR score should be externally validated.This work was supported by Instituto de Salud Carlos III and Fondos Europeos de Desarrollo Regional FEDER (grant numbers PI20/00637, PI15/00531, and CIBERCV16/11/00486,CIBERCV16/11/00420, CIBERCV16/11/00479), apostgraduate contract FI18/00320 to C.R.-N., CM21/00175 to V.M.-G. and JR21/00041 to C.B., Fundacio La MaratoTV3 (grant 20153030-31-32), La Caixa Banking Foundation (HR17-00527), by Conselleria de Educacion-Generalitat Valenciana (PROMETEO/2021/008) and by Sociedad Espanola de Cardiologia (grant SEC/FEC-INV-CLI 21/024). J.G. acknowledges financial support from the Agencia Estatal de Investigacion (grant FJC2020-043981-I/AEI/10.13039/501100011033). D.M. acknowledges financial support from the Conselleria d'Educacio,Investigacio, Cultura i Esport, Generalitat Valenciana (grants AEST/2019/037, AEST/2020/029).Gabaldón-Pérez A; Marcos-Garcés, V.; Gavara-Doñate, J.; López-Lereu, MP.; Monmeneu, JV.; Pérez, N.; Ríos-Navarro, C.... (2022). Prognostic value of cardiac magnetic resonance early after ST-segment elevation myocardial infarction in older patients. Age and Ageing. 51(11):1-11. https://doi.org/10.1093/ageing/afac248111511

Incidence, Outcomes, and Predictors of Ventricular Thrombus after Reperfused ST-Segment-Elevation Myocardial Infarction by Using Sequential Cardiac MR Imaging

[EN] Purpose: To characterize the incidence, outcomes, and predictors of left ventricular (LV) thrombus by using sequential cardiac magnetic resonance (MR) imaging after ST-segment-elevation myocardial infarction (STEMI). Materials and Methods: Written informed consent was obtained from all patients, and the study protocol was approved by the committee on human research. In a cohort of 772 patients with STEMI, 392 (mean age, 58 years; range, 24-89 years) were retrospectively selected who were studied with cardiac MR imaging at 1 week and 6 months. Cardiac MR imaging guided the initiation and withdrawal of anticoagulants. Patients with LV thrombus at 6 months were restudied at 1 year. For predicting the occurrence of LV thrombus, a multiple regression model was applied. Results: LV thrombus was detected in 27 of 392 patients (7%): 18 (5%) at 1 week and nine (2%) at 6 months. LV thrombus resolved in 22 of 25 patients (88%) restudied within the first year. During a mean follow-up of 181 weeks 6 168, patients with LV thrombus displayed a very low rate of stroke (0%), peripheral embolism (0%), and severe hemorrhage (n = 1, 3.7%). LV ejection fraction (LVEF) less than 50% (P < .001) and anterior infarction (P = .008) independently helped predict LV thrombus. The incidence of LV thrombus was as follows: (a) nonanterior infarction, LVEF 50% or greater (one of 135, 1%); (b) nonanterior infarction, LVEF less than 50% (one of 50, 2%); (c) anterior infarction, LVEF 50% or greater (two of 92, 2%); and (d) anterior infarction, LVEF less than 50% (23 of 115, 20%) (P < .001 for the trend). Conclusion: Cardiac MR imaging contributes information for the diagnosis and therapy of LV thrombus after STEMI. Patients with simultaneous anterior infarction and LVEF less than 50% are at highest risk. (C) RSNA, 2017Study supported by Instituto de Salud Carlos III and FEDER (CB16/11/00486, PI14/00271, PIE15/00013) and Generalitat Valenciana (PROMETEO/2013/007).Cambronero-Cortinas, E.; Bonanad, C.; Monmeneu, J.; López-Lereu, M.; Gavara-Doñate, J.; De Dios, E.; Rios, C.... (2017). Incidence, Outcomes, and Predictors of Ventricular Thrombus after Reperfused ST-Segment-Elevation Myocardial Infarction by Using Sequential Cardiac MR Imaging. Radiology. 284(2):372-380. https://doi.org/10.1148/radiol.2017161898S372380284