Objectives This study sought to determine the incidence and prognostic significance of persistent iron in patients post–ST-segment elevation myocardial infarction (STEMI).

Background The clinical significance of persistent iron within the infarct core after STEMI complicated by acute myocardial hemorrhage is poorly understood.

Methods Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction]). Cardiac magnetic resonance imaging including T₂* (observed time constant for the decay of transverse magnetization seen with gradient-echo sequences) mapping was performed at 2 days and 6 months post-STEMI. Myocardial hemorrhage or iron was defined as a hypointense infarct core with T₂* signal <20 ms.

Results A total of 203 patients (age 57 ± 11 years, n = 158 [78%] male) had evaluable T₂* maps at 2 days and 6 months post-STEMI; 74 (36%) patients had myocardial hemorrhage at baseline, and 44 (59%) of these patients had persistent iron at 6 months. Clinical associates of persistent iron included heart rate (p = 0.009), the absence of a history of hypertension (p = 0.017), and infarct size (p = 0.028). The presence of persistent iron was associated with worsening left ventricular (LV) end-diastolic volume (regression coefficient: 21.10; 95% confidence interval [CI]: 10.92 to 31.27; p < 0.001) and worsening LV ejection fraction (regression coefficient: −6.47; 95% CI: −9.22 to −3.72; p < 0.001). Persistent iron was associated with the subsequent occurrence of all-cause death or heart failure (hazard ratio: 3.91; 95% CI: 1.37 to 11.14; p = 0.011) and major adverse cardiac events (hazard ratio: 3.24; 95% CI: 1.09 to 9.64; p = 0.035) (median follow-up duration 1,457 days [range 233 to 1,734 days]).

Conclusions Persistent iron at 6 months post-STEMI is associated with worse LV and longer-term health outcomes. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850)

目的本研究旨在确定ST段抬高型心肌梗死（STEMI）患者中持久性铁的发生率和预后意义。

背景技术对STEMI并发急性心肌出血后梗死灶内持久性铁的临床意义了解甚少。

方法将患有急性STEMI的患者纳入一项队列研究（BHF MR-MI [ST抬高型心肌梗死中心脏损伤的检测和意义]）。在STEMI后2天和6个月进行包括T ₂ *（用梯度回波序列观察到的横向磁化强度衰减的观察时间常数）作图的心脏磁共振成像。心肌出血或铁被定义为T ₂ *信号<20 ms的高发性梗塞核心。

结果共有203例患者（年龄57±11岁，n = 158 [78％]男性）具有可评估的T ₂*在STEMI后2天零6个月绘制地图；74（36％）例患者在基线时有心肌出血，其中44例（59％）者在6个月时持续铁。持续性铁的临床相关因素包括心率（p = 0.009），无高血压病史（p = 0.017）和梗死面积（p = 0.028）。持续铁的存在与左心室舒张末期容积恶化（回归系数：21.10； 95％置信区间[CI]：10.92至31.27； p <0.001）和左室射血分数恶化（回归系数：- 6.47； 95％CI：-9.22至-3.72； p <0.001）。持久铁与随后发生的全因死亡或心力衰竭（危险比：3.91； 95％CI：1.37至11.14； p = 0.011）和主要的不良心脏事件（危险比：3.24； 95％CI：1.09）相关。至9.64； p = 0。

结论STEMI后6个月的铁持续摄入与左室恶化和长期健康相关。（ST段抬高型心肌梗死[BHF MR-MI]； NCT02072850）的心脏损伤检测及其意义