Residual ischemia by stress CMR in stable post-STEMI patients. Association with clinical events and implications of guided revascularization
Notice bibliographique
Résumé
Abstract Introduction Stress cardiac magnetic resonance (sCMR) represents a gold standard approach to identify and localize myocardial ischemia. However, in the setting of stable STEMI patients, data on the prognostic implications of residual ischemia as derived from sCMR are scarce. Moreover, the association of sCMR-guided revascularization with angina class improvement and patients’ outcomes is unknown. Objectives To evaluate the implications of residual ischemia and sCMR related revascularization with prognosis and anginal symptoms of STEMI patients after the index event. Material and methods Reperfused, stable STEMI patients submitted to undergo sCMR within the first year after STEMI were included in the registry. We analyzed the association of residual ischemia and sCMR related revascularization with the occurrence of major adverse cardiac events (MACE), comprised of all-cause death, non-fatal myocardial infarction, re-admission for heart failure, or unplanned revascularization. Additionally, we explored the effect of sCMR related revascularization on angina class as derived from the Canadian Cardiovascular Society (CCS) Angina Score. A p-value <0.05 was considered statistically significant. Results The study group was made up of 234 patients who underwent sCMR for evaluation of non-revascularized lesions in the non-culprit arteries (n=139, 59.4%) or assessment of new onset chest pain (n=95, 40.6%). Residual ischemia was noted in a minority of patients (n=63, 26.9%), and most of them presented with mild or moderate ischemic burden (n=56, 88.9% with residual ischemia in ≤5 myocardial segments). During a median follow up of 7.49 [3.03-10.02] years, 78 (33.3%) patients presented MACE. In multivariate analysis, the extent (number of segments) of residual ischemia did not associate with MACE (HR 0.97 [0.83-1.12] per segment, p=0.65). Patients were categorized in 3 groups: Group 1 (G1, no ischemia-no revascularization, n=166), Group 2 (G2, ischemia-no revascularization, n=29), and Group 3 (G3, ischemia-revascularization, n=34). No differences in survival free from MACE were noted between these groups. Most patients (n=192, 84.6%) were in CCS Angina Score Class I before sCMR. Patients in G1 remained asymptomatic or paucisymptomatic during follow-up (CCS II-IV between 4.8 and 9%, p>0.05). In G3, patients were predominantly in CCS II-IV (52.9%) before sCMR, and a significant reduction in anginal symptoms was noted after revascularization (CCS II-IV between 6.5 and 12.1%, p≤0.001). Patients with ischemia on sCMR but no revascularization (G2) depicted higher proportion of patients with CCS II-IV before (24.1%) and after sCMR (13 to 19.2%, p>0.05). Conclusions In STEMI patients evaluated post-discharge in stable phase, residual ischemia as derived from sCMR is usually mild and does not associate with the occurrence of MACE. sCMR-guided revascularization relates to a significant and sustained improvement of anginal symptoms but not to the event rate.Survival free from MACE.Changes in CCS Angina Score.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».