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

Abstract

Introduction 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]). Objectives and methods 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. Results 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<0.01); highest tertiles of these 3 parameters predicted 24 month MACE (log-rank <0.01). Multi-variable binary logistic regression analysis showed 72h hsTnT levels predicted 24-month MACE (p<0.01). Conclusion Post-PCI treatment of STEMI, hsTnT levels measured ?48h and Selvester QRS scoring correlated with CMRI-determined IS. These parameters predicted MACE at 24 months and should be routinely assessed for post-STEMI risk stratification. Copyright: � 2024 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.