| Predicting late myocardial recovery and outcomes in the early hours of ST-segment elevation myocardial infarction traditional measures compared with microvascular obstruction, salvaged myocardium, and necrosis characteristics by cardiovascular magnetic resonance. | |
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MedLine Citation:
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PMID: 20510213 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The aim of this study was to determine whether a very early imaging strategy improves the prediction of late systolic dysfunction and poor outcomes in ST-segment elevation myocardial infarction (STEMI) compared with traditional predictors. BACKGROUND: Earlier prediction of poor outcomes after STEMI is desirable, because it will allow tailored therapy at the earliest possible time, when benefits might be greatest. METHODS: One hundred and three patients with acute STEMI were studied by contrast-enhanced cardiovascular magnetic resonance within 12 h of primary angioplasty and at 6 months and followed >2 years. The primary end point was left ventricular (LV) dysfunction, whereas poor outcomes were a key secondary end point. RESULTS: Traditional risk factors were only modest predictors of late LV dysfunction. Late gadolinium enhancement (LGE) volume maintained a stronger association to LV ejection fraction change than infarct transmurality, microvascular obstruction, or myocardial salvage during STEMI (p = 0.02). Multivariable logistic regression identified LGE volume during STEMI as the best predictor of late LV dysfunction (odds ratio: 1.36, p = 0.03). An LGE >or=23% of LV during STEMI accurately predicted late LV dysfunction (sensitivity 89%, specificity 74%). The LGE volume provided important incremental benefit for predicting late dysfunction (area under the curve = 0.92, p <or= 0.03 vs. traditional risk factors). Twenty-three patients developed poor outcomes (1 death, 2 myocardial infarctions, 5 malignant arrhythmias, 4 severe LV dysfunction <35%, 11 hospital stays for heart failure) over 2.6 +/- 0.9 years; LGE volume remained a strong independent predictor of poor outcomes, whereas LGE >or=23% carried a hazard ratio of 6.1 for adverse events (p < 0.0001). CONCLUSIONS: During the hyperacute phase of STEMI, LGE volume provides the strongest association and incremental predictive value for late systolic dysfunction and discerns poor late outcomes. |
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Authors:
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Eric Larose; Josep Rodés-Cabau; Philippe Pibarot; Stéphane Rinfret; Guy Proulx; Can M Nguyen; Jean-Pierre Déry; Onil Gleeton; Louis Roy; Bernard Noël; Gérald Barbeau; Jacques Rouleau; Jean-Rock Boudreault; Marc Amyot; Robert De Larochellière; Olivier F Bertrand |
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Publication Detail:
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Type: Comment; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 55 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-31 Completed Date: 2010-06-15 Revised Date: 2011-01-24 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 2459-69 Citation Subset: AIM; IM |
Affiliation:
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Département Multidisciplinaire de Cardiologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec and Faculté de Médicine de l'Université Laval, Québec City, Québec, Canada. eric.larose@criucpq.ulaval.ca <eric.larose@criucpq.ulaval.ca> |
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Balloon, Coronary
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methods,
mortality Area Under Curve Cohort Studies Contrast Media / diagnostic use Coronary Circulation / physiology Electrocardiography* Female Follow-Up Studies Gadolinium / diagnostic use Humans Image Enhancement Linear Models Magnetic Resonance Imaging, Cine* Male Middle Aged Multivariate Analysis Myocardial Contraction / physiology Myocardial Infarction / diagnosis*, mortality, therapy* Myocardium / pathology* Necrosis Predictive Value of Tests Prospective Studies ROC Curve Severity of Illness Index Stroke Volume Survival Analysis Treatment Outcome Ventricular Remodeling* |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media; 7440-54-2/Gadolinium |
| Comments/Corrections | |
Comment On:
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J Am Coll Cardiol. 2010 Jun 1;55(22):2489-90
[PMID:
20510216
]
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Comment In:
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J Am Coll Cardiol. 2011 Jan 11;57(2):221-2; author reply 222
[PMID:
21211696
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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