Tissue Characterization in STEMI Using Cardiac MRI: a Multicenter Registry

Adverse left ventricular remodeling after STEMI is a key determinant of long-term morbidity and mortality. Although primary PCI and guideline-directed therapies have improved outcomes, 10-15% of patients still develop adverse remodeling and heart failure. CMR enables precise measurement of infarct size, left ventricular volumes, ejection fraction, microvascular obstruction, and tissue parameters (T1, extracellular volume), which may enhance risk stratification compared with other imaging techniques.

The registry is based on harmonized clinical and imaging datasets from three experienced centers in Spain, forming a large repository of standardized variables. This structure facilitates the identification of predictors of infarct size, ventricular remodeling, and major adverse cardiac events (MACE), and provides a framework for the development of improved prognostic models and the exploration of potential therapeutic targets.

Inclusion criteria

• Age ≥ 18 years
• First STEMI evaluated within the first 24 hours of symptom onset
• At least one CMR performed during the acute phase
• Signed informed consent (for prospective patients) or previous consent (for retrospective inclusion).

Exclusion criteria

• Severe renal failure (GFR < 30 ml/min)
• STEMI > 24 hours after symptom onset
• Contraindications to CMR (e.g., claustrophobia, hemodynamic instability, non-MR-compatible devices, vascular clips)
• Pregnancy or breastfeeding.