Prediction of long-term major events soon after a first ST-segment elevation myocardial infarction by cardiovascular magnetic resonance

Eur J Radiol. 2016 Mar;85(3):585-92. doi: 10.1016/j.ejrad.2015.12.012. Epub 2015 Dec 21.


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.

Methods and 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.

Keywords: Cardiovascular magnetic resonance; Myocardial infarction; Prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Edema / complications
  • Edema / pathology
  • Female
  • Follow-Up Studies
  • Hemorrhage / complications
  • Hemorrhage / pathology
  • Humans
  • Magnetic Resonance Spectroscopy / methods*
  • Male
  • Microvessels / pathology
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / pathology*
  • Myocardium / pathology
  • Prospective Studies
  • Registries
  • Reproducibility of Results
  • Time
  • Ventricular Dysfunction, Left / complications
  • Ventricular Dysfunction, Left / pathology