Document Detail

Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction.
MedLine Citation:
PMID:  20510214     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of the study was to determine the prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance (CMR) in reperfused ST-segment elevation myocardial infarction.
BACKGROUND: In acute myocardial infarction, CMR can retrospectively detect the myocardium at risk and the irreversible injury. This allows for quantifying the extent of salvaged myocardium after reperfusion as a potential strong end point for clinical trials and outcome.
METHODS: We analyzed 208 consecutive ST-segment elevation myocardial infarction patients 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 categorized into 2 groups defined by the median MSI. The primary end point of the study was occurrence of major adverse cardiovascular events defined as death, reinfarction, and occurrence of new congestive heart failure within 6 months after the index event.
RESULTS: The median MSI was 48 (interquartile range 27 to 73). Major adverse cardiovascular events were significantly lower in the MSI >or= median group (2.9% vs. 22.1%, p < 0.001). The stepwise Cox proportional hazards model revealed that the MSI was the strongest predictor of major adverse cardiovascular events at 6-month follow-up (p < 0.001). All prognostic clinical (symptom onset to reperfusion), angiographic (Thrombolysis In Myocardial Infarction flow grade before angioplasty), and electrocardiographic (ST-segment resolution) parameters showed significant correlations with the MSI (p < 0.001 for all).
CONCLUSIONS: This study for the first time demonstrates that the MSI assessed by CMR predicts the outcome in acute reperfused ST-segment elevation myocardial infarction. Therefore, MSI assessment has important implications for patient prognosis as well as for the design of future trials intended to test new reperfusion therapy efficacy. (Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance-Impact on Outcome; NCT00952224).
Ingo Eitel; Steffen Desch; Georg Fuernau; Lysann Hildebrand; Matthias Gutberlet; Gerhard Schuler; Holger Thiele
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Publication Detail:
Type:  Clinical Trial; Comment; Comparative Study; Journal Article    
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:  2470-9     Citation Subset:  AIM; IM    
Heart Center, Department of Internal Medicine-Cardiology, University of Leipzig, Leipzig, Germany. <>
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MeSH Terms
Angioplasty, Balloon, Coronary / methods*,  mortality
Chi-Square Distribution
Coronary Angiography / methods
Follow-Up Studies
Magnetic Resonance Imaging, Cine / methods*
Middle Aged
Myocardial Infarction / diagnosis*,  mortality,  therapy*
Myocardium / pathology*
Prospective Studies
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Survival Analysis
Time Factors
Treatment Outcome
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 ]
Curr Cardiol Rep. 2011 Feb;13(1):3-5   [PMID:  20878369 ]

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