A Novel Method in the Stratification of Post-Myocardial-Infarction Patients Based on Pathophysiology

PLoS One. 2015 Jun 19;10(6):e0130158. doi: 10.1371/journal.pone.0130158. eCollection 2015.

Abstract

Objectives: We proposed that the severity of ST-segment elevation myocardial infarction (STEMI) could be classified based on pathophysiological changes.

Methods: First-STEMI patients were classified within hospitalization. Grade 0: no detectable myocardial necrosis; Grade 1: myocardial necrosis without functional and morphological abnormalities; Grade 2: myocardial necrosis with reduced LVEF; Grade 3: reduced LVEF on the basis of cardiac remodeling; Grade 4: mitral regurgitation additional to the Grade-3 criteria.

Results: Of 180 patients, 1.7, 43.9, 26.1, 23.9 and 4.4% patients were classified as Grade 0 to 4, respectively. The classification is an independent predicator of 90-day MACEs (any death, resuscitated cardiac arrest, acute heart failure and stroke): the rate was 0, 5.1, 8.5, 48.8 and 75% from Grade 0 to 4 (p < 0.001), respectively. The Grade-2 patients were more likely to have recovered left ventricular ejection fraction than the Grade-3/4 patients did after 90 days (48.9% vs. 19.1%, p < 0.001). Avoiding complicated quantification, the classification served as a good reflection of infarction size as measured by cardiac magnetic resonance imaging (0 ± 0, 15.68 ± 8.48, 23.68 ± 9.32, 36.12 ± 11.35 and 40.66 ± 14.33% of the left ventricular mass by Grade 0 to 4, P < 0.001), and with a comparable prognostic value (AUC 0.819 vs. 0.813 for infarction size, p = 0.876 by C-statistics) for MACEs.

Conclusions: The new classification represents an easy and objective method to scale the cardiac detriments for STEMI patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Comorbidity
  • Disease Progression
  • Echocardiography
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / physiopathology*
  • Prognosis
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Ventricular Function, Left
  • Ventricular Remodeling

Grants and funding

This work has been supported by the Program of Shanghai Hospital Development Center (SHDC 12013119, for BH); International Cooperation Program of Shanghai Committee of Science and Technology (12410708300, for BH); Shanghai Leading Medical Talents Program and Shanghai Leading Talents Program (LJ 10007, for BH); Program of Joint Research for Major Diseases from Shanghai committee of hygiene and family plan (2014ZYJB0501 for BH); Program for New Century Excellent Talents in University from Ministry of Education of China (NCET-12-0352 for BH) and National Natural Science Foundation of China (81400261, 81270282). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.