A Noncontrast CMR Risk Score for Long-Term Risk Stratification in Reperfused ST-Segment Elevation Myocardial Infarction
Heerajnarain Bulluck, Jaclyn Carberry, David Carrick, Peter J McCartney, Annette M Maznyczka, John P Greenwood, Neil Maredia, Saqib Chowdhary, Anthony H Gershlick, Clare Appleby, James M Cotton, Andrew Wragg, Nick Curzen, Margaret McEntegart, Mark C Petrie, Hany Eteiba, Stuart Watkins, Mitchell Lindsay, Ahmed Mahrous, Keith G Oldroyd, Colin Berry, Heerajnarain Bulluck, Jaclyn Carberry, David Carrick, Peter J McCartney, Annette M Maznyczka, John P Greenwood, Neil Maredia, Saqib Chowdhary, Anthony H Gershlick, Clare Appleby, James M Cotton, Andrew Wragg, Nick Curzen, Margaret McEntegart, Mark C Petrie, Hany Eteiba, Stuart Watkins, Mitchell Lindsay, Ahmed Mahrous, Keith G Oldroyd, Colin Berry
Abstract
Objectives: This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure.
Background: A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI).
Methods: The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score.
Results: There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score.
Conclusions: This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).
Keywords: ST-segment elevation myocardial infarction; cardiac magnetic resonance; risk.
Conflict of interest statement
Funding Support and Author Disclosures Funding was provided by a British Heart Foundation Grant (RE/18/6134217; PG/11/2/28474) and the Chief Scientist Office. Dr Berry was supported by a Senior Fellowship from the Scottish Funding Council. The T-TIME trial was funded by the Efficacy and Mechanism Evaluation program of the National Institute for Health Research. Boehringer Ingelheim United Kingdom Ltd provided the study drugs and matched placebo. Part of this project was supported by a research agreement with Siemens Healthcare. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed