Head-to-head comparison of 1 week versus 6 months CMR-derived infarct size for prediction of late events after STEMI
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Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in >50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4–9] vs. 3 [1–5], p < .0001) and a larger SS at 6 months (5 [2–6] vs. 3 [1–5], p = .005) than those without MACE. Late MACE rates in IS >median were higher at 1 week (14 vs. 4 %, p = .007) and in SS >median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14–1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.
KeywordsCardiovascular magnetic resonance ST-elevation myocardial infarction Prognosis Late gadolinium enhancement imaging
This work was supported by the “Instituto de Salud Carlos III” (PI1102323 grant). O. Husser was supported by the “Regensburger Forschungsförderung in der Medizin (ReForM)”.
Conflict of interest
No conflict of interest exists in the present study.
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