title: Comprehensive prognosis assessment by CMR imaging after ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Although the prognostic value of findings from cardiac magnetic resonance (CMR) imaging has been established in single-center center studies in patients with ST-segment elevation myocardial infarction (STEMI), a large multicenter investigation to evaluate the prognostic significance of myocardial damage and reperfusion injury is lacking.
  
  
  OBJECTIVE
  The aim of this study was to assess the prognostic impact of CMR in an adequately powered multicenter study and to evaluate the most potent CMR predictor of hard clinical events in a STEMI population treated by primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  We enrolled 738 STEMI patients in this CMR study at 8 centers. The patients were reperfused by primary PCI <12 h after symptom onset. Central core laboratory-masked analyses for quantified left ventricular (LV) function, infarct size (IS), microvascular obstruction (MO), and myocardial salvage were performed. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events.
  
  
  RESULTS
  Patients with cardiovascular events had significantly larger infarcts (p < 0.001), less myocardial salvage (p = 0.01), a larger extent of MO (p = 0.009), and more pronounced LV dysfunction (p < 0.001). In a multivariate model that included clinical and other established prognostic parameters, MO remained the only significant predictor in addition to the TIMI (Thrombolysis In Myocardial Infarction) risk score. IS and MO provided an incremental prognostic value above clinical risk assessment and LV ejection fraction (c-index increase from 0.761 to 0.801; p = 0.036).
  
  
  CONCLUSIONS
  In a large, multicenter STEMI population reperfused by primary PCI, CMR markers of myocardial damage (IS and especially MO) provide independent and incremental prognostic information in addition to clinical risk scores and LV ejection fraction. (Abciximab i.v. Versus i.c. in ST-elevation Myocardial Infarction [AIDA STEMI]; NCT00712101).
authors.affiliation: Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany; Department of Cardiology, Angiology, Intensive Care Medicine, University of Lübeck, Medical Clinic II, Lübeck, Germany. Electronic address: ingoeitel@gmx.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany; Department of Cardiology, Heart Center Bad Segeberg, Bad Segeberg, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.affiliation: Department of Internal Medicine II-Cardiology, University of Ulm, Ulm, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Wöhrle
authors.affiliation: Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.affiliation: Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Phillipp
authors.initials: P
authors.lastname: Lurz
authors.affiliation: Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pauschinger
authors.affiliation: Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany; Department of Cardiology, Angiology, Intensive Care Medicine, University of Lübeck, Medical Clinic II, Lübeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Internal Medicine-Cardiology, University of Leipzig-Heart Center, Leipzig, Germany; Department of Cardiology, Angiology, Intensive Care Medicine, University of Lübeck, Medical Clinic II, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D016037:Single-Blind Method; D015996:Survival Rate / Q000639:trends
keywords: magnetic resonance imaging; myocardial infarction; prognosis