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A Validated Echocardiographic Risk Model for Predicting Outcome Following ST-segment Elevation Myocardial Infarction

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Many echocardiographic measures have been proposed as potential predictors of outcome following ST-elevation myocardial infarction (STEMI). We hypothesized that combining multiple echocardiographic measures in a risk model provides more prognostic information than individual echocardiographic measures. We prospectively included 373 STEMI patients which constituted our derivation cohort. We also identified 298 STEMI patients from a clinical registry that constituted our validation cohort. Echocardiogram was performed at a median of 2 days after infarction. The echocardiogram consisted of conventional and advanced measures. The end point was a composite of heart failure and/or cardiovascular death. During a median follow-up of 5.4 years, we observed 80 events in our derivation cohort. A stepwise backward Cox regression including all echocardiographic parameters identified global longitudinal strain, wall motion score index (WMSI), E/e', and E/global strain rate e (E/GLSRe) as significant predictors of outcome. A Classification and Regression Tree analysis outlined a risk model with WMSI, GLSRe, and E/e' as key echocardiographic parameters. Patients with WMSI ≥ 2.22 were at high risk, patients with WMSI < 2.22, GLSRe < 0.82s-1 and E/e'≥7.6 at intermediate risk, and patients with WMSI < 2.22 and GLSRe ≥ 0.82s-1 or GLSRe < 0.82s-1 and E/e' < 7.6 at low risk of heart failure and/or cardiovascular death. When compared with the low-risk group, an incremental risk was observed (intermediate group: HR = 2.52 [1.24;5.11], p = 0.011; high-risk group: HR = 4.37 [1.40;13.66], p = 0.011). The risk model was validated in the validation cohort (C-statistic: 0.71). In conclusion, we devised an echocardiographic risk model for STEMI patients suggesting advanced and conventional measures of systolic function and filling pressures to be important for the prognosis.

Original languageEnglish
JournalThe American journal of cardiology
Volume125
Issue number10
Pages (from-to)1461-1470
Number of pages10
ISSN0002-9149
DOIs
Publication statusPublished - 15 May 2020

    Research areas

  • Aged, Denmark, Echocardiography/methods, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention, Predictive Value of Tests, Prognosis, Prospective Studies, Registries, Risk Assessment, ST Elevation Myocardial Infarction/diagnostic imaging

ID: 61295331