Determinants and Prognostic Value of Early Gadolinium Enhancement-Derived Myocardial Salvage Index in STEMI
Authors' conclusion
EGE-derived MSI was associated with prepercutaneous coronary intervention Thrombolysis in Myocardial Infarction flow and microvascular injuries. It was an independent predictor of major adverse cardiac events. Our results highlight the prognostic potential of EGE imaging in acute myocardial infarction.
Study context
- Population
- Reperfused patients with ST-segment-elevation myocardial infarction undergoing acute cardiac magnetic resonance, April 2017 to July 2023mean age, 60±12 years, 389 men
- Participants
- 453 patients
- Exposure
- Early gadolinium enhancement (EGE)-derived myocardial salvage index and major adverse cardiac events
- Outcome
- Major adverse cardiac events
- Follow-up
- Median 3.2 years (interquartile range, 1.6-4.7 years)
Methodological detailssingle center
- Single center
Main finding
As reported in the abstract
At least one major adverse cardiac event
91 participants
20.1%
Observational data: associations, not effects.
Further findings
Independent determinants of myocardial salvage index (MSI) (linear regression)
| β | P value | |
|---|---|---|
| Prepercutaneous coronary intervention Thrombolysis in Myocardial Infarction flow | 3.35 | P < 0.001 |
| Microvascular obstruction | −11.92 | P < 0.001 |
| Outcome | Hazard ratio (95% CI) | P value | |
|---|---|---|---|
| Major adverse cardiac event risk per 10% increase in MSI (multivariable Cox regression)32% reduction in major adverse cardiac event risk · multivariable | 0.68 (0.53–0.86) | P = 0.001 | |
| 0.512Hazard ratio (log scale) |
MSI
- Median MSI
- 35.0% (interquartile range, 22.9-59.5%)
- Smaller MSI observed in patients with larger infarcts
- P < 0.001
Cardiovascular death and reinfarction
- A graded response was observed between MSI and cardiovascular death and reinfarction
Reinfarction with MSI greater than the median
- Nontarget vessel-related reinfarctions
- P = 0.027
- Target vessel-related reinfarctions
- P = 0.36
Reproducibility of EGE-measured area at risk
- Intraobserver ICC
- 0.95
- Interobserver ICC
- 0.89
Original publication
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