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Characteristics and Prognostic Implications of Myocardial Tissue Injury Stages in STEMI Using the CCS Classification

https://doi.org/10.1007/s00392-025-02625-4

Ivan Lechner (Innsbruck)1, M. Reindl (Innsbruck)1, J. Carberry (Glasgow)2, T. Stiermaier (Lübeck)3, C. Tiller (Innsbruck)1, M. Holzknecht (Innsbruck)1, F. Oberhollenzer (Innsbruck)1, A. Kaser (Innsbruck)1, J. Mair (Innsbruck)1, A. Mayr (Innsbruck)4, H.-J. Feistritzer (Leipzig)5, D. Carrick (Glasgow)2, A. Bauer (Innsbruck)1, H. Thiele (Leipzig)5, I. Eitel (Lübeck)3, B. Metzler (Innsbruck)1, C. Berry (Glasgow)2, S. J. Reinstadler (Innsbruck)1

1Medizinische Universität Innsbruck Department für Innere Medizin III - Kardiologie und Angiologie Innsbruck, Österreich; 2Universität von Glasgow Cardiovascular Research Centre Glasgow, Großbritannien; 3Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; 4Medizinische Universität Innsbruck Univ.-Klinik für Radiologie Innsbruck, Österreich; 5Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland

 

Background: Myocardial infarction (MI) involves progressive tissue damage beyond necrosis. The recently proposed Canadian Cardiovascular Society (CCS) classification defines this damage in four stages, potentially optimizing personalized risk stratification and advancing research on cardioprotective treatments. The exact role and prognostic implications of this classification remains to be explored.

Aim: To compare clinical characteristics across CCS stages and to validate their prognostic implications in patients with ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention.

Methods and Results: We analysed 1,109 STEMI patients included in three prospective studies. Magnetic resonance imaging (MRI) was performed 3 (2-5) days after MI and patients were classified as follows: stage 1 (aborted MI), stage 2 (MI with necrosis and absence of microvascular injury), stage 3 (MI with necrosis and microvascular obstruction) and stage 4 (MI with necrosis and intramyocardial haemorrhage). Our analysis revealed distinct patterns of clinical presentation, biomarker profiles and cardiac function at different CCS stages. We observed differences in adverse clinical event rates and mortality between CCS stages (Major adverse cardiovascular event [MACE]: 0.7%, 3.4%, 3.1%, 15.7%, p<0.001 and mortality: 0.7%, 1.7%, 0.9%, 6.3%, p<0.001). The CCS stage had a strong predictive value for MACE and mortality (AUC 0.74 [95% CI: 0.68-0.80], p<0.001 and AUC 0.71 [95% CI: 0.61-0.80], p<0.001) at 12 months, respectively.

Conclusion: This study describes clinical characteristics across CCS stages and provides insights into the prognostic implications of the different stages of tissue injury severity in a large cohort of STEMI patients. These data should inform the use of CCS stages in future trial design.
 
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