title: Head-to-head comparison of 1 week versus 6 months CMR-derived infarct size for prediction of late events after STEMI.
abstract: Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in >50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4-9] vs. 3 [1-5], p < .0001) and a larger SS at 6 months (5 [2-6] vs. 3 [1-5], p = .005) than those without MACE. Late MACE rates in IS >median were higher at 1 week (14 vs. 4 %, p = .007) and in SS >median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14-1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.
authors.affiliation: Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universidad de Valencia, Blasco Ibanez 17, 46010, Valencia, Spain, oliver.husser@gmail.com.
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Jose V
authors.initials: JV
authors.lastname: Monmeneu
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.forename: Cristina
authors.initials: C
authors.lastname: Gomez
authors.forename: Fabian
authors.initials: F
authors.lastname: Chaustre
authors.forename: Julio
authors.initials: J
authors.lastname: Nunez
authors.forename: Maria P
authors.initials: MP
authors.lastname: Lopez-Lereu
authors.forename: Gema
authors.initials: G
authors.lastname: Minana
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Luis
authors.initials: L
authors.lastname: Mainar
authors.forename: Vicente
authors.initials: V
authors.lastname: Ruiz
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Forteza
authors.forename: Isabel
authors.initials: I
authors.lastname: Trapero
authors.forename: David
authors.initials: D
authors.lastname: Moratal
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodi
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013997:Time Factors