title: Prognosis after ST-elevation myocardial infarction: a study on cardiac magnetic resonance imaging versus clinical routine.
abstract: BACKGROUND
  This study aimed to evaluate the incremental prognostic value of infarct size, microvascular obstruction (MO), myocardial salvage index (MSI), and left ventricular ejection fraction (LV-EFCMR) assessed by cardiac magnetic resonance imaging (CMR) in comparison to traditional outcome markers in patients with ST-elevation myocardial infarction (STEMI) reperfused by primary percutaneous intervention (PCI).
  
  
  METHODS
  STEMI patients reperfused by primary PCI (n=278) within 12 hours after symptom onset underwent CMR three days after the index event (interquartile range [IQR] two to four). Infarct size and MO were measured 15 minutes after gadolinium injection. T2-weighted and contrast-enhanced CMR were used to calculate MSI. In addition, traditional outcome markers such as ST-segment resolution, pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI)-flow, maximum level of creatine kinase-MB, TIMI-risk score, and left ventricular ejection fraction assessed by echocardiography were determined in all patients. Clinical follow-up was conducted after 19 months (IQR 10 to 27). The primary endpoint was defined as a composite of death, myocardial reinfarction, and congestive heart failure (MACE).
  
  
  RESULTS
  In multivariable Cox regression analysis, adjusting for all traditional outcome parameters significantly associated with the primary endpoint in univariable analysis, MSI was identified as an independent predictor for the occurrence of MACE (Hazard ratio 0.94, 95% CI 0.92 to 0.96, P<0.001). Further, C-statistics comparing a model including only traditional outcome markers to a model including CMR parameters on top of traditional outcome markers revealed an incremental prognostic value of CMR parameters (0.74 versus 0.94, P<0.001).
  
  
  CONCLUSIONS
  CMR parameters such as infarct size, MO, MSI, and LV-EFCMR add incremental prognostic value above traditional outcome markers alone in acute reperfused STEMI.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00463749, Clinicaltrials.gov NCT00359918.
authors: Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Strümpellstr, 39, 04289 Leipzig, Germany. s-dw@gmx.net.
authors: Suzanne
authors: S
authors: de Waha
authors: Ingo
authors: I
authors: Eitel
authors: Steffen
authors: S
authors: Desch
authors: Georg
authors: G
authors: Fuernau
authors: Philipp
authors: P
authors: Lurz
authors: Thomas
authors: T
authors: Stiermaier
authors: Stephan
authors: S
authors: Blazek
authors: Gerhard
authors: G
authors: Schuler
authors: Holger
authors: H
authors: Thiele
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002986:Clinical Trials as Topic; D003287:Contrast Media; D003326:Coronary Circulation; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol