Document Detail


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.
MedLine Citation:
PMID:  20510213     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Comment; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  2010-05-31     Completed Date:  2010-06-15     Revised Date:  2011-01-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2459-69     Citation Subset:  AIM; IM    
Affiliation:
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:
Angioplasty, Balloon, Coronary / 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:
0/Contrast Media; 7440-54-2/Gadolinium
Comments/Corrections
Comment On:
J Am Coll Cardiol. 2010 Jun 1;55(22):2489-90   [PMID:  20510216 ]
Comment In:
J Am Coll Cardiol. 2011 Jan 11;57(2):221-2; author reply 222   [PMID:  21211696 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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