Cine Images Derived-Radiomic for the Prediction of Event Free Survival in Patients With ST-Segment Elevation Myocardial Infarction

Rationale and Objectives To evaluate the prognostic value of radiomic features derived from contrast-free cine cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI). Materials and Methods We retrospectively included 440 patients with acute STEMI (86.6% males, 56.9 ± 10.6 years of age), who underwent CMR one week after percutaneous coronary intervention. Patients were assigned by centers into a development cohort ( n = 359) and a validation cohort ( n = 81). Radiomic features were extracted from cine images. Feature selection was performed using random survival forest and least absolute shrinkage and selection operator (LASSO)-Cox regression to generate a radiomics-based risk score (RAD score). Discrimination was evaluated using logistic and Cox regression analysis. Results During the median follow-up period of 2.9 years, 88 patients experienced major adverse cardiovascular events (MACE). The RAD score provided incremental prognostic value over the clinical model in the internal (C-index 0.86 [0.79–0.92] vs 0.65 [0.55–0.78]; p < 0.001) and external cohort (C-index 0.80 [0.70–0.91] vs 0.63 [0.48–0.78]; p = 0.014), comparable to the clinical + LGE-CMR model (C-index 0.80 [0.70–0.91] vs 0.77 [0.65–0.89]; p = 0.547). Receiver operating characteristic analyses were consistent with C-index findings. After adjusting for established risk factors, RAD score-defined high risk remained independently associated with MACE (HR 11.30, 95% CI 4.96–21.44; p < 0.001). Conclusion Cine-CMR radiomics provides independent and incremental prognostic information after STEMI and attains predictive performance comparable to parameters from cardiac magnetic resonance with late gadolinium enhancement, supporting contrast-free, individualized risk stratification.