https://doi.org/10.1007/s00392-025-02625-4
1Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie Bad Krozingen, Deutschland; 2Institut für Medizinische Biometrie und Statistik am Universitätsklinikum Freiburg Freiburg, Deutschland; 3Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland
Background: The extent of myocardial scar, visualized by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR), is associated with major adverse cardiovascular events (MACE) following ST-segment elevation myocardial infarction (STEMI). However, data on non-ST-segment elevation myocardial infarction (NSTEMI) and optimal cardiac biomarker cut-off values (e.g., high-sensitivity cardiac troponin T, hs-cTnT) for predicting myocardial scar formation after acute myocardial infarction (MI) remain limited.
Aims: This study aimed to evaluate the predictive value of cardiac biomarkers for myocardial scar formation and their influence on clinical outcome.
Methods and results: We included 597 patients who underwent CMR 3 days [interquartile range (IQR) 2–4 days] post-MI (407 STEMI and 190 NSTEMI patients), with a follow-up period of 3.0 years [IQR 1.3–3.5 years]. Patients with LGE had significantly lower left ventricular ejection fraction (LVEF) and higher peak cardiac biomarker levels compared to those without LGE (P < 0.001 for each). After adjusting for key variables, maximum cardiac biomarker levels were found to have the strongest correlation with both the presence and extent of LGE (P < 0.001). Absolute LGE mass (in grams), rather than LGE percentage, was the most robust predictor of all-cause mortality (hazard ratio 1.464 [1.050–2.040], P = 0.025), with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.73 and an optimal cut-off of 53 g. Additionally, a maximum hs-cTnT cut-off of 7270 ng/L was identified to predict an LGE mass of at least 53 g.
Conclusion: In a large cohort of acute MI patients with a three-year follow-up, we demonstrated a strong correlation between maximum cardiac biomarker levels (e.g., hs-cTnT) and the extent of myocardial scar. Absolute LGE mass (≥ 53 g) emerged as the strongest predictor of all-cause mortality, with hs-cTnT levels of ≥ 7270 ng/L serving as a reliable indicator of significant myocardial damage. These findings may lead to a more targeted use of CMR in post-MI patients.