Simple indices of infarct size post ST-Elevation Myocardial Infarction (STEMI) provides similar risk stratification to cardiac MRI

• Published in: PloS one 2024-11, Vol.19 (11), p.e0311157
• Main Authors: Sharma, Lokesh, Faour, Amir, Nguyen, Tuan, Dimitri, Hany, Vo, Giau, Otton, James, Burgess, Sonya, Juergens, Craig, French, John
• Format: Article
• Language: English
• Subjects: Aged; Biology and Life Sciences; Biomarkers; Biomarkers - blood; Care and treatment; Cerebral infarction; Clinical outcomes; Computer simulation; Congestive heart failure; Echocardiography; EKG; Electrocardiography; Evaluation; Female; Heart attack; Heart attacks; Humans; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medicine and Health Sciences; Middle Aged; Myocardial infarction; Parameter sensitivity; Patient outcomes; Patients; Percutaneous Coronary Intervention; Prognosis; Prospective Studies; Regression analysis; Research and Analysis Methods; Risk assessment; Risk Assessment - methods; Sensitivity analysis; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - pathology; ST Elevation Myocardial Infarction - physiopathology; ST Elevation Myocardial Infarction - surgery; Statistical analysis; Troponin; Troponin T; Troponin T - blood
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0311157

Myocardial Infarct Size (IS) determined soon after ST-segment elevation myocardial infarction (STEMI) has prognostic significance, and can be assessed by cardiac biomarker levels, electrocardiographic (ECG) parameters, and imaging modalities (including echocardiography and cardiac magnetic resonance imaging [CMRI]). We evaluated methods of IS assessment, 12-lead ECG Selvester QRS scores and high-sensitivity Troponin T (hsTnT) levels measured ≥48hr (plateau phase of hsTnT elevation), compared to paired CMRIs and echocardiograms, in a prospective cohort of patients with STEMI undergoing percutaneous coronary intervention (PCI) during the index hospitalisation. Associations were determined between IS, as assessed by these methods, and 24-month major adverse cardiac events (MACE), a hierarchical composite of: death, stroke and hospitalization for heart failure. Of 233 patients undergoing early CMRI after STEMI, 211 patients (86% male; 54% anterior MI) had first STEMIs, median age 56 years [interquartile range 50-64], of whom 165 (78%) underwent primary PCI and 46 (22%) pharmaco-invasive PCI. Ejection fraction improved from 48% [42-54] acutely to 52% [44-60] at 2 months (p< 0.05). Plateau phase hsTnT levels, QRS scoring and CMRI-determined IS post-STEMI correlated for anterior MIs (all comparisons r>0.4, p