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      Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction : Recent Advances, Controversies, and Future Directions

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          Abstract

          Although mortality after ST-segment elevation myocardial infarction (MI) is on the decline, the number of patients developing heart failure as a result of MI is on the rise. Apart from timely reperfusion by primary percutaneous coronary intervention, there is currently no established therapy for reducing MI size. Thus, new cardioprotective therapies are required to improve clinical outcomes after ST-segment-elevation MI. Cardiovascular magnetic resonance has emerged as an important imaging modality for assessing the efficacy of novel therapies for reducing MI size and preventing subsequent adverse left ventricular remodeling. The recent availability of multiparametric mapping cardiovascular magnetic resonance imaging has provided new insights into the pathophysiology underlying myocardial edema, microvascular obstruction, intramyocardial hemorrhage, and changes in the remote myocardial interstitial space after ST-segment-elevation MI. In this article, we provide an overview of the recent advances in cardiovascular magnetic resonance imaging in reperfused patients with ST-segment-elevation MI, discuss the controversies surrounding its use, and explore future applications of cardiovascular magnetic resonance in this setting.

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          A tale of coronary artery disease and myocardial infarction.

          Elizabeth G. Nabel, Eugene Braunwald (2012)
          Article 0 comments Cited 119 times – based on 0 reviews     Review now
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            Comprehensive prognosis assessment by CMR imaging after ST-segment elevation myocardial infarction.

            Ingo Eitel, Suzanne de Waha, Jochen Wöhrle … (2014)
            Although the prognostic value of findings from cardiac magnetic resonance (CMR) imaging has been established in single-center center studies in patients with ST-segment elevation myocardial infarction (STEMI), a large multicenter investigation to evaluate the prognostic significance of myocardial damage and reperfusion injury is lacking. The aim of this study was to assess the prognostic impact of CMR in an adequately powered multicenter study and to evaluate the most potent CMR predictor of hard clinical events in a STEMI population treated by primary percutaneous coronary intervention (PCI). We enrolled 738 STEMI patients in this CMR study at 8 centers. The patients were reperfused by primary PCI <12 h after symptom onset. Central core laboratory-masked analyses for quantified left ventricular (LV) function, infarct size (IS), microvascular obstruction (MO), and myocardial salvage were performed. The primary clinical endpoint of the study was the occurrence of major adverse cardiac events. Patients with cardiovascular events had significantly larger infarcts (p < 0.001), less myocardial salvage (p = 0.01), a larger extent of MO (p = 0.009), and more pronounced LV dysfunction (p < 0.001). In a multivariate model that included clinical and other established prognostic parameters, MO remained the only significant predictor in addition to the TIMI (Thrombolysis In Myocardial Infarction) risk score. IS and MO provided an incremental prognostic value above clinical risk assessment and LV ejection fraction (c-index increase from 0.761 to 0.801; p = 0.036). In a large, multicenter STEMI population reperfused by primary PCI, CMR markers of myocardial damage (IS and especially MO) provide independent and incremental prognostic information in addition to clinical risk scores and LV ejection fraction. (Abciximab i.v. Versus i.c. in ST-elevation Myocardial Infarction [AIDA STEMI]; NCT00712101). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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              Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction.

              Justin A Ezekowitz, Padma Kaul, Jeffery A. Bakal … (2009)
              The purpose of this study was to examine the long-term incidence of heart failure (HF) in elderly patients with myocardial infarction (MI). In-hospital HF is common after MI and is associated with poor short-term prognosis. Limited data exist concerning the long-term incidence or prognosis of HF after MI, particularly in the era of coronary revascularization. A population-based cohort of 7,733 patients > or = 65 years of age hospitalized for a first MI (International Classification of Diseases-9th Revision-Clinical Modification code 410.x) and without a prior history of HF was established between 1994 and 2000 in Alberta, Canada, and followed up for 5 years. During the index MI hospitalization, 2,831 (37%) MI patients were diagnosed with new HF and 1,024 (13%) died. Among hospital survivors who did not have HF during their index hospitalization (n = 4,291), an additional 3,040 patients (71%) developed HF by 5 years, 64% of which occurred in the first year. In total, 5,871 (76%) elderly patients who survived their first MI developed HF over 5 years. Among those who survived the index hospitalization, the 5-year mortality rate was 39.1% for those with HF during the index MI hospitalization compared with 26.7% among those without HF (p < 0.0001) during the index MI hospitalization. Over the study period, the 5-year mortality rate after MI decreased by 28%, whereas the 5-year rate of HF increased by 25%. In this large cohort of elderly patients without a history of HF, HF developed in three-quarters in the 5 years after their first MI; this proportion increased over time as peri-MI mortality rates declined. New-onset HF significantly increases the mortality risk among these patients.
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                Author and article information

                Journal
                Title: Circulation
                Abbreviated Title: Circulation
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0009-7322
                ISSN (Electronic): 1524-4539
                Publication date Created: May 2018
                Publication date (Print): May 2018
                Volume: 137
                Issue: 18
                Pages: 1949-1964
                Affiliations
                [1 ]Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.).
                [2 ]Royal Papworth Hospital, Cambridge, United Kingdom (H.B.).
                [3 ]Biomedical Imaging Research Institute and Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.D.).
                [4 ]Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (R.D.).
                [5 ]Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (A.E.A.).
                [6 ]British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (C.B.).
                [7 ]National Institute of Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (D.J.H.).
                [8 ]Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (D.J.H.).
                [9 ]National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).
                [10 ]Cardiovascular and Metabolic Disorders Program, Duke–National University of Singapore, Singapore (D.J.H.).
                Article
                DOI: 10.1161/CIRCULATIONAHA.117.030693
                PMC ID: 5933067
                PubMed ID: 29712696
                SO-VID: eaf3c9de-a534-4eee-aa2a-4f385ee1710c
                Copyright © © 2018
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