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A noncontrast CMR risk score for long-term risk stratification in reperfused ST-segment elevation myocardial infarction

A noncontrast CMR risk score for long-term risk stratification in reperfused ST-segment elevation myocardial infarction
A noncontrast CMR risk score for long-term risk stratification in reperfused ST-segment elevation myocardial infarction

OBJECTIVES: This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure.

BACKGROUND: A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI).

METHODS: The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score.

RESULTS: There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score.

CONCLUSIONS: This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).

ST-segment elevation myocardial infarction, cardiac magnetic resonance, risk
1876-7591
431-440
Bulluck, Heerajnarain
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Carberry, Jaclyn
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Carrick, David
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McCartney, Peter J
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Maznyczka, Annette M
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Greenwood, John P
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Maredia, Neil
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Chowdhary, Saqib
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Gershlick, Anthony H
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Appleby, Clare
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Cotton, James M
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Wragg, Andrew
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Curzen, Nick
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McEntegart, Margaret
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Petrie, Mark C
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Eteiba, Hany
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Watkins, Stuart
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Lindsay, Mitchell
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Mahrous, Ahmed
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Oldroyd, Keith G
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Berry, Colin
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Bulluck, Heerajnarain
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Carberry, Jaclyn
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Carrick, David
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McCartney, Peter J
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Maznyczka, Annette M
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Greenwood, John P
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Maredia, Neil
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Chowdhary, Saqib
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Gershlick, Anthony H
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Appleby, Clare
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Cotton, James M
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Wragg, Andrew
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Curzen, Nick
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McEntegart, Margaret
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Petrie, Mark C
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Eteiba, Hany
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Watkins, Stuart
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Lindsay, Mitchell
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Mahrous, Ahmed
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Oldroyd, Keith G
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Berry, Colin
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Bulluck, Heerajnarain, Carberry, Jaclyn, Carrick, David, McCartney, Peter J, Maznyczka, Annette M, Greenwood, John P, Maredia, Neil, Chowdhary, Saqib, Gershlick, Anthony H, Appleby, Clare, Cotton, James M, Wragg, Andrew, Curzen, Nick, McEntegart, Margaret, Petrie, Mark C, Eteiba, Hany, Watkins, Stuart, Lindsay, Mitchell, Mahrous, Ahmed, Oldroyd, Keith G and Berry, Colin (2022) A noncontrast CMR risk score for long-term risk stratification in reperfused ST-segment elevation myocardial infarction. JACC. Cardiovascular imaging, 15 (3), 431-440. (doi:10.1016/j.jcmg.2021.08.006).

Record type: Article

Abstract

OBJECTIVES: This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure.

BACKGROUND: A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI).

METHODS: The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score.

RESULTS: There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score.

CONCLUSIONS: This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).

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Accepted/In Press date: 11 August 2021
e-pub ahead of print date: 12 January 2022
Published date: 7 March 2022
Keywords: ST-segment elevation myocardial infarction, cardiac magnetic resonance, risk

Identifiers

Local EPrints ID: 456575
URI: http://eprints.soton.ac.uk/id/eprint/456575
ISSN: 1876-7591
PURE UUID: 9ec03322-8236-4a24-b992-74563efc9dd1
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 05 May 2022 16:38
Last modified: 12 Jan 2023 05:01

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Contributors

Author: Heerajnarain Bulluck
Author: Jaclyn Carberry
Author: David Carrick
Author: Peter J McCartney
Author: Annette M Maznyczka
Author: John P Greenwood
Author: Neil Maredia
Author: Saqib Chowdhary
Author: Anthony H Gershlick
Author: Clare Appleby
Author: James M Cotton
Author: Andrew Wragg
Author: Nick Curzen ORCID iD
Author: Margaret McEntegart
Author: Mark C Petrie
Author: Hany Eteiba
Author: Stuart Watkins
Author: Mitchell Lindsay
Author: Ahmed Mahrous
Author: Keith G Oldroyd
Author: Colin Berry

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