AI-ECG for Predicting CMR-Defined Myocardial Injury in Acute Myocardial Infarction

Yonsei University461 enrolled

Overview

This retrospective, single-center external validation study evaluates whether two commercially approved artificial intelligence-enhanced electrocardiography (AI-ECG) algorithms (AiTiA LVSD and AiTiA MI; Medical AI Co., Ltd.), applied to a single pre-percutaneous coronary intervention (PCI) 12-lead ECG, predict cardiac magnetic resonance (CMR)-defined myocardial injury in patients with acute myocardial infarction (AMI). The primary endpoint is a large infarct (late gadolinium enhancement \>17.9% of left ventricular mass); secondary endpoints are CMR left ventricular ejection fraction (LVEF) ≤40% and microvascular obstruction (MVO).

Consecutive patients with acute myocardial infarction undergoing PCI and subsequent CMR at Yongin Severance Hospital (April 2020-June 2025) were identified. Two approved AI-ECG algorithms were applied to the first 12-lead ECG obtained at emergency-department presentation (pre-PCI). CMR was performed a median of 3 days (IQR 2-5) after PCI. The diagnostic performance of each AI-ECG score for the CMR-defined endpoints was assessed by the area under the ROC curve (AUC), with sensitivity, specificity, and predictive values at prespecified and cohort-optimal (Youden) cutoffs, and by logistic regression. The final analysis cohort comprised 461 patients.

Study Type

OBSERVATIONAL

Enrollment

461

Conditions

Acute Myocardial Infarction (AMI)

Eligibility

Sex: ALLMin age: 19 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Acute myocardial infarction (STEMI or NSTEMI) undergoing PCI * Subsequent cardiac magnetic resonance imaging performed * Valid pre-PCI 12-lead ECG processable by both AI-ECG algorithms Exclusion Criteria: * Duplicate AMI enrollment * Invalid ECG-CMR date linkage * No valid pre-PCI 12-lead ECG processable by both algorithms

Outcomes

Primary Outcomes

Large myocardial infarct on CMR

: Late gadolinium enhancement (LGE) \>17.9% of left ventricular mass, assessed on CMR. Discrimination of the pre-PCI AI-ECG score reported as AUC.

Time frame: CMR performed a median of 3 days (IQR 2-5) after PCI, during the index hospitalization.

Secondary Outcomes

CMR-defined LV systolic dysfunction

CMR-derived left ventricular ejection fraction (LVEF) ≤40%.

Time frame: CMR performed a median of 3 days (IQR 2-5) after PCI.

Microvascular obstruction (MVO)

Presence of microvascular obstruction on CMR.