Risk stratification in patients discharged for STEMI. Ejection fraction by echocardiography as the gatekeeper for a selective use of cardiac magnetic resonance

Abstract Background CMR permits robust risk stratification of discharged STEMI patients but an indiscriminate use in all cases is unfeasible. Purpose We evaluated the usefulness of left ventricular ejection fraction (LVEF) by echocardiography (Echo) as the gatekeeper for identifying those patients d...

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Published in:European heart journal 2020-11, Vol.41 (Supplement_2)
Main Authors: Marcos Garces, V, Gavara, J, Lopez-Lereu, M.P, Monmeneu, J.V, Rios-Navarro, C, De Dios, E, Merenciano-Gonzalez, H, Gabaldon-Perez, A, Bonanad, C, Chorro, F.J, Valente, F, Lorenzatti, D, Rodriguez-Palomares, J.F, Ortiz, J.T, Bodi, V
Format: Article
Language:English
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Summary:Abstract Background CMR permits robust risk stratification of discharged STEMI patients but an indiscriminate use in all cases is unfeasible. Purpose We evaluated the usefulness of left ventricular ejection fraction (LVEF) by echocardiography (Echo) as the gatekeeper for identifying those patients discharged for ST-segment elevation myocardial infarction (STEMI) who benefit most from cardiac magnetic resonance (CMR) for prognostic purposes. Methods Echo and CMR were performed in 1119 patients discharged for STEMI included in a multicenter registry. The prognostic power of CMR beyond Echo-LVEF was assessed using C-statistic, net reclassification index (NRI) and integrated discrimination improvement index (IDI). Results During a 4.8-year median follow-up, 136 (12%) first major adverse cardiac events (MACE) occurred (47 cardiovascular deaths and 89 re-admissions for acute heart failure). Lesser Echo-LVEF and CMR-LVEF associated with the occurrence of MACE but only CMR-LVEF and microvascular obstruction were independent predictors. The MACE rate significantly increased only in patients with CMR-LVEF
ISSN:0195-668X
1522-9645
DOI:10.1093/ehjci/ehaa946.0323