Prognostic Value of a Comprehensive Cardiac Magnetic Resonance Assessment Soon After a First ST-Segment Elevation Myocardial Infarction

ObjectivesTo evaluate the prognostic value of a comprehensive cardiac magnetic resonance (CMR) assessment soon after a first ST-segment elevation myocardial infarction (STEMI).BackgroundCMR allows for a simultaneous assessment of wall motion abnormalities (WMA), WMA with low-dose dobutamine (WMA-dobutamine), microvascular obstruction, and transmural necrosis. This approach has been proven to be useful to predict late systolic recovery soon after STEMI. Its prognostic value and the relative prognostic weight of these indexes are not well-defined.MethodsWe studied 214 consecutive patients with a first STEMI treated with thrombolytic therapy or primary angioplasty discharged from hospital. In the first week (7 ± 1 day after infarction), with CMR we determined the extent (number of segments) of WMA, WMA-dobutamine, microvascular obstruction, and transmural necrosis.ResultsDuring a median follow-up of 553 days, 21 major adverse cardiac events (MACE) including 4 cardiac deaths, 6 nonfatal myocardial infarctions, and 11 readmissions for heart failure were documented. The MACE was associated with a larger extent of WMA (8 ± 4 segments vs. 5 ± 3 segments, p < 0.001), WMA-dobutamine (6 ± 4 segments vs. 4 ± 3 segments, p = 0.004), microvascular obstruction (3 ± 3 segments vs. 1 ± 2 segments p