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. 2024 Nov 21;19(11):e0311157.
doi: 10.1371/journal.pone.0311157. eCollection 2024.

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

Lokesh Sharma  1   2 , Amir Faour  1   2 , Tuan Nguyen  1   2 , Hany Dimitri  1   2 , Giau Vo  2 , James Otton  1   2 , Sonya Burgess  1   2   3 , Craig Juergens  1   2 , John French  1   2   4
Affiliations

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

Lokesh Sharma et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Consort diagram.
Of the 211 patients with initial STEMI, 9 were missing follow-up ECGs and 9 were missing follow-up MRIs.
Fig 2
Fig 2. Scatter plots of binary correlations between Selvester scores, Troponin T levels and CMRI derived infarct size.
A: Selvester QRS score and CMRI infarct size–Acute (n = 211). B: Selvester QRS score and CMRI infarct size–Follow-up (n = 199). C: Acute CMRI Infarct Size and 48-hour hsTnT levels (n = 209). D: Acute Selvester QRS score and 48-hour hsTnT levels (n = 209). Green Circles: non-anterior infarction patients. Blue Squares: anterior infarction patients. Green line: regression line for non-anterior MI. Blue line: regression line for anterior MI.
Fig 3
Fig 3. Kaplan-Meier curves of freedom from MACE.
A: Comparisons are shown between tertiles of: Acute QRS Selvester scores. B: 48-Hour hsTnT levels. C: Acute CMRI infarct size (Log-rank p = 0.173). Blue Line (low), Green Line (intermediate) and Red Line (high) tertiles.
See this image and copyright information in PMC

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