title: Prediction of long-term major events soon after a first ST-segment elevation myocardial infarction by cardiovascular magnetic resonance.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) predicts combined clinical events in post-ST-segment elevation myocardial infarction (STEMI) patients. However, its contribution to predicting long-term major events (ME: cardiac death and non-fatal myocardial infarction [MI]) is unknown. We aimed to assess whether CMR predicts long-term MEs when performed soon after STEMI.
  
  
  RESULTS
  We prospectively recruited 546 STEMI patients between 2004 and 2012. The Left ventricular (LV) ejection fraction (LVEF,%), infarct size (IS), edema, hemorrhage, microvascular obstruction, and myocardial salvage were quantified by CMR at pre-discharge. During a mean follow-up of 840 days, 57 ME events (10%; 23 cardiac deaths, 34 non-fatal MIs) were documented. Patients with MEs has more depressed LVEFs (p<0.001), larger ISs (p<0.001), more extensive edema, hemorrhage, and microvascular obstruction, and lower myocardial salvage (p<0.05). CMR indexes were dichotomized according to the best cutoff values for predicting ME. In a comprehensive multivariate model, a LVEF<40% (HR: 2.3; 95% CI [12, 43]; p= 0.009) and an IS>30% of LV mass (HR: 2.4; 95% CI [13, 44]; p= 0.007) independently doubled the ME risk. The ME risk rates were 6%, 14%, and 30%, respectively (p<0.001) in patients with both the LVEF≥40% and an IS≤30% of LV mass (n=393), those with only one altered value (n=84), and in cases with both the LVEF<40% and an IS>30% of LV mass (n=69). Similar tendencies were observed regarding cardiac deaths (2%, 6%, 14%; p<0.001) and MI (4%, 8%, 16%; p < 0.001).
  
  
  CONCLUSIONS
  CMR performed soon after STEMI predicts long-term MEs. Combined analysis of CMR-derived LVEF and IS allows robust stratification of patient outcomes.
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Clara
authors: C
authors: Bonanad
authors: Cardiovascular Magnetic Resonance Unit. ERESA. Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Jose V
authors: JV
authors: Monmeneu
authors: Cardiovascular Magnetic Resonance Unit. ERESA. Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Maria P
authors: MP
authors: Lopez-Lereu
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Arantxa
authors: A
authors: Hervas
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Elena
authors: E
authors: de Dios
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Jose
authors: J
authors: Gavara
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Julio
authors: J
authors: Nunez
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Gema
authors: G
authors: Minana
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Oliver
authors: O
authors: Husser
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Ana
authors: A
authors: Paya
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Paolo
authors: P
authors: Racugno
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Sergio
authors: S
authors: García-Blas
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
authors: Francisco J
authors: FJ
authors: Chorro
authors: Department of Cardiology. Hospital Clinico Universitario. INCLIVA. University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain. Electronic address: vicente.bodi@uv.es.
authors: Vicente
authors: V
authors: Bodi
mesh_terms: D004487:Edema / Q000150:complications / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000150:complications / Q000473:pathology; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D013995:Time; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000473:pathology
keywords: Cardiovascular magnetic resonance; Myocardial infarction; Prognosis