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Original article
Long-term prognostic value of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction
  1. Ingo Eitel1,2,
  2. Steffen Desch1,2,
  3. Suzanne de Waha1,2,
  4. Georg Fuernau1,2,
  5. Matthias Gutberlet3,
  6. Gerhard Schuler1,2,
  7. Holger Thiele1,2
  1. 1Department of Internal Medicine, University of Leipzig, Heart Center, Leipzig, Germany
  2. 2Department of Cardiology, University of Leipzig, Heart Center, Leipzig, Germany
  3. 3Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany
  1. Correspondence to Dr Ingo Eitel, University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Strümpellstr. 39, Leipzig 04289, Germany; ingoeitel{at}gmx.de

Abstract

Objective In acute myocardial infarction, cardiovascular magnetic resonance (CMR) allows for quantifying the extent of salvaged myocardium after reperfusion as a potential strong end point for clinical trials. The aim of this study was to investigate whether the early prognostic significance of myocardial salvage assessed by CMR is sustained at long-term clinical follow-up in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty.

Design, setting, patients We analysed 208 consecutive patients with STEMI undergoing primary angioplasty <12 h after symptom onset. T2-weighted and contrast-enhanced CMR was used to calculate the myocardial salvage index (MSI). Patients were categorised into two groups defined by the median MSI. The primary end point was the occurrence of major adverse cardiovascular events defined as death, reinfarction and new congestive heart failure at long-term follow-up.

Results The median MSI was 48 (IQR 27 to 73). Long-term follow-up was available in 202 patients (97%) at a median of 18.5 months (IQR 13.8 to 20.8). Major adverse cardiovascular events occurred in 33 patients (16%), with a significantly lower event rate in the MSI ≥ median group (7 vs 26 events, p<0.001). Mortality was significantly reduced in the MSI ≥ median group (2 vs 12 deaths, p=0.001). MSI was a significant independent predictor for a favourable long-term survival on multivariable Cox regression analysis after adjustment for established prognostic markers.

Conclusions MSI assessed by CMR predicts long-term clinical outcome in acute reperfused STEMI. Therefore, our data support the use of myocardial salvage as an end point for clinical trials investigating novel reperfusion strategies.

Trial registration number http://www.ClinicalTrials.gov: NCT00952224.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics committee of the University of Leipzig.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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