Objectives This study assessed the prognostic significance of remote zone native T1 alterations for the prediction of clinical events in a population with ST-segment elevation myocardial infarction (STEMI) who were treated by primary percutaneous coronary intervention (PPCI) and compared it with conventional markers of infarct severity.

Background The exact role and incremental prognostic relevance of remote myocardium native T1 mapping alterations assessed by cardiac magnetic resonance (CMR) after STEMI remains unclear.

Methods We included 255 consecutive patients with STEMI who were reperfused within 12 h after symptom onset. CMR core laboratory analysis was performed to assess left ventricular (LV) function, standard infarct characteristics, and native T1 values of the remote, noninfarcted myocardium. The primary endpoint was a composite of death, reinfarction, and new congestive heart failure within 6 months (major adverse cardiac events [MACE]).

Results Patients with increased remote zone native T1 values (>1,129 ms) had significantly larger infarcts (p = 0.012), less myocardial salvage (p = 0.002), and more pronounced LV dysfunction (p = 0.011). In multivariable analysis, remote zone native T1 was independently associated with MACE after adjusting for clinical risk factors (p = 0.001) or other CMR variables (p = 0.007). In C-statistics, native T1 of remote myocardium provided incremental prognostic information beyond clinical risk factors, LV ejection fraction, and other markers of infarct severity (all p < 0.05). The addition of remote zone native T1 to a model of prognostic CMR parameters (ejection fraction, infarct size, and myocardial salvage index) led to net reclassification improvement of 0.82 (95% confidence interval: 0.46 to 1.17; p < 0.001) and to an integrated discrimination improvement of 0.07 (95% confidence interval: 0.02 to 0.13; p = 0.01).

Conclusions In STEMI patients treated by PPCI, evaluation of remote zone alterations by quantitative noncontrast T1 mapping provided independent and incremental prognostic information in addition to clinical risk factors and traditional CMR outcome markers. Remote zone alterations may thus represent a novel therapeutic target and a useful parameter for optimized risk stratification. (Effect of Conditioning on Myocardial Damage in STEMI [LIPSIA-COND]; NCT02158468)

目的这项研究评估了原发性经皮冠状动脉介入治疗（PPCI）治疗的ST段抬高型心肌梗死（STEMI）人群中偏远区天然T1改变对预测临床事件的预后意义，并将其与常规标志物进行了比较。梗塞严重程度。

背景技术STEMI后通过心脏磁共振（CMR）评估的远端心肌天然T1定位改变的确切作用和预后相关性仍不清楚。

方法我们纳入了255例连续的STEMI患者，他们在症状发作后的12小时内进行了再灌注。进行了CMR核心实验室分析，以评估左心室（LV）功能，标准梗死特征以及远端，非梗死心肌的天然T1值。主要终点是6个月内死亡，再梗塞和新发充血性心力衰竭（主要不良心脏事件[MACE]）的综合结果。

结果偏远区天然T1值升高（> 1,129 ms）的患者梗死面积明显更大（p = 0.012），心肌抢救较少（p = 0.002），并且LV功能障碍更明显（p = 0.011）。在多变量分析中，在调整了临床风险因素（p = 0.001）或其他CMR变量（p = 0.007）之后，偏远区本地T1独立地与MACE相关。在C统计量中，远处心肌的天然T1提供了更多的预后信息，超过了临床危险因素，左室射血分数和其他梗塞严重程度标志物（所有p <0.05）。在预后CMR参数模型（射血分数，梗塞面积和心肌挽救指数）中增加偏远区本机T1可使净重分类改善0.82（95％置信区间：0.46至1.17; p <0。

结论在接受PPCI治疗的STEMI患者中，通过定量非造影剂T1映射评估远端区域改变，除了临床危险因素和传统CMR结果指标外，还提供了独立和递增的预后信息。远程区域改变因此可以代表新的治疗靶标和用于优化风险分层的有用参数。（条件对STEMI心肌损伤的影响[LIPSIA-COND]； NCT02158468）