Myocardial salvage may predict long-term adverse outcomes in STEMI
MedWire News: Myocardial salvage index (MSI), assessed by cardiovascular magnetic resonance (CMR) imaging, predicts long-term adverse outcomes in STEMI patients, report German researchers.
The data support the use of myocardial salvage as an endpoint in clinical trials investigating novel reperfusion strategies, write Ingo Eitel and co-workers from the University of Leipzig, in the journal Heart.
The researchers analyzed 208 consecutive patients (202 of whom had follow-up data available) with STEMI, who underwent primary angioplasty less than 12 hours after symptom onset. They used T2-weighted and contrast-enhanced CMR to calculate the MSI of each patient, then classified them into two groups using the median MSI of 48.3 as a cut-point.
Major adverse cardiovascular events (MACE), defined as death, reinfarction, and new congestive heart failure at long-term follow-up (median 18.5 months), occurred in 33 patients (16%), with a significantly lower rate occurring in patients with an MSI of 48.3 or greater, at 7 events, than those with an MSI of less than 48.3, at 26 events (p<0.001).
Mortality was also significantly reduced in the group with an MSI greater than the median, compared with the other group (2 vs 12 deaths, respectively, p=0.001).
Multivariate analysis, adjusted for established prognostic markers, revealed that MSI as a continuous variable was an independent predictor of mortality.
Moreover, the area under the receiver-operating characteristic curve score (AUC) showed that MSI was a strong indicator of MACE and mortality at long-term follow-up. Indeed, compared with late microvascular obstruction and infarct size, MSI was the strongest indicator for mortality, with an AUC of 0.79.
"The prognostic relevance of myocardial salvage might also help to select patients who may benefit from intensification of medical or device treatment," write the authors.
"However, further studies are needed to prove the clinical relevance of myocardial-salvage-guided treatment decisions," they conclude.
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By Piriya Mahendra