Multi-biomarker approach for predicting cardiac magnetic resonance parameters at 30 days after ST-segment elevation myocardial infarction.

BACKGROUND

Established biomarkers are used for risk stratification after STEMI, but their relationship with cardiac magnetic resonance (CMR)-derived infarct characteristics at 30 days remains incompletely understood. Because 30-day CMR reflects an intermediate post-infarction stage between acute myocardial injury and the later chronic infarct state, we evaluated whether baseline high-sensitivity troponin T (hsTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), cellular communication network factor 1 (CCN1), and proprotein convertase subtilisin/kexin type 9 (PCSK9) are associated with 30-day CMR parameters.

METHODS

In this pre-specified CLEVER-ACS substudy, associations between baseline biomarkers and 30-day CMR parameters were assessed using Spearman correlation. Receiver operating characteristic (ROC) analysis with area under the curve (AUC) was performed for associations after median dichotomization. Exploratory analyses assessed associations with relative CMR changes.

RESULTS

56 STEMI patients were analyzed. hsTnT and NT-proBNP showed the strongest association pattern across functional, structural, volumetric, and microvascular 30-day CMR parameters. CCN1 was associated only with left ventricular ejection fraction (LVEF), and PCSK9 showed no significant associations. hsTnT and NT-proBNP showed relevant discriminatory performance for parameters including LVEF (AUC 0.79, 95% CI 0.67-0.91, and 0.81 [0.69-0.93]), left ventricular scar (0.87 [0.77-0.96] and 0.76 [0.63-0.89]), scar mass (0.84 [0.74-0.95] and 0.79 [0.67-0.91]), and microvascular obstruction (0.72 [0.56-0.87] and 0.71 [0.55-0.86]), respectively. Exploratory analyses linked only hsTnT and NT-proBNP to changes in CMR parameters.

CONCLUSIONS

Baseline hsTnT and NT-proBNP showed strong associations with 30-day CMR parameters after STEMI, whereas CCN1 and PCSK9 provided no discriminatory value in this intermediate post-infarction stage.